Why Diet WON’T Increase Your Lifespan! (LONGEVITY MYTHS) | Peter Attia

the higher that level the longer you're going to live there is no number there is no biomarker there's no finding in all of biology that is more predictive of a person's length of life than that specific number you have a quote in the book that goes something like I used to think that diet and nutrition were the cure-alls and now I'm not so sure how is it possible that diet and nutrition which would have been the thing and I've said many times in the show if if you just let me control a hundred percent what people eat I I've got them covered I'll control their body composition but the one thing I always caveated was I don't know that I'll keep them alive longer because I'm running an NF1 experiment so what made you start to lose faith that diet and nutrition were the answer well I think it's important to differentiate between a couple of things so I definitely don't want um what I've written or what you've correctly interpreted to imply to people that I don't think nutrition is important right what I'm really saying is nutrition is an asymmetric input to the equation if we want to think about it technically meaning it has far more downside if you get it wrong than it has upside if you get it right that's interesting does that make sense yeah so getting it wrong will really hurt you getting it right man it's not going to make you live to 200. that's right I mean first of all I don't think anything will but yes that's the right idea no absolutely not so so if you get it wrong and let's be clear we are living in a case study of getting it wrong right MO the standard American diet is all about getting it wrong for virtually everybody so we're we're watching proof positive what it means to get it wrong but what I want people to understand is it's very easy to get to that point where you think okay I'm going to fixate on this thing and it's going to get better and that's wonderful by the way if you do but you're if you do that at the exclusion of some of the other things namely exercise um you're really leaving an opportunity on the table an exercise has more of a symmetric upside and downside in other words if you are not exercising or you're not exercising sufficiently there's a huge downside but unlike nutrition if you get exercise right there's enormous upside there is true life extension and Remarkable Health span extension which might be even more important I'm really I'm bothered by that and it's bothered by that because I hate exercise dude in a way that you can't imagine so literally while while I was reading your book which I always do as an audio format I was doing um air squats and sit-ups and stuff because just hearing you talk about the importance of exercise it really is the thing that I have always done out of obligation and never out of Joy so I always thought again literally until reading your book that I was way better off controlling diet and you get this the classic phrase you can't outrun a bad diet can you like are you saying you can well again we wanted so that's a complicated answer which we'll take in steps so there's probably a season in your life when you can generally when you're young and if that exercise is at a high enough level you can so just using my own personal example absolutely when I was growing up so in my teenage years right 13 to 19 I didn't pay any attention to what I ate other than I was always eating and when I say I was always eating I'm not exaggerating right like I every morning breakfast was a box of Froot Loops or Captain Crunch or some unbelievable crap that could only be consumed in a tupperware bowl bigger than my head nice and you know with a liter of milk lunch was usually seven sandwiches oh my God it's a full loaf of bread what were you doing I was exercising six hours a day Jesus were you a wrestler or something boxer oh yes so you know running minimum five typically closer to 10 miles every morning 25 minutes of rope jump two and a half hours of weight training sparring bag work every single day 400 push-ups before bed every single night with one exception One Night in high school I didn't make it happen wow you actually remember that it was only one time one night I was so goddamn sick that I couldn't get out of bed for a whole day and that was the only night in all of high school I didn't do my 400 push-ups before but I was so pissed off that even now you remember that there was one day I love it but my point is I didn't stop eating I was eating french fries crap all day every day I couldn't gain weight I was trying to move up a weight class I couldn't because of the exercise or your genetic Proclaim oh I just think I mean that that much exercise you're you can eat whatever you want um now could I exercise that much today could I exercise could I out exercise a bad diet today no at 50 I can't do what I could do when I was 15. right I want to get into the mechanisms of that so here's another one of my ignorant statements that I live by uh this is all a game of controlling your glucose and that if you let me control your glucose levels then I basically control your destiny and I want everybody listening to know that after reading this book I know this is probably not only overly simplistic but maybe even just wrong correct but uh in exercising like that it feels like okay well you're burning all that glucose so the glucose isn't going in and wreaking havoc on your system um are you saying now mechanistically that at this age I guess like you either I think there's two things going on right one I simply couldn't do I I don't think I could do in one I don't think I could do four one day what I did for five years every day just two taxing on the system it's just too difficult like I don't have the physical capacity to go like today if I went out and ran 10 miles I'd be beat for the rest of the day like that would be my day whereas I had done that before six in the morning every day and I was just getting started so I simply can't do what I used to be able to do so I think that's just a big part of it but also as we age for reasons that are not entirely clear we do become less metabolically healthy our mitochondria become less efficient our muscles become more insulin resistant part of that's driven by hormones part of that's driven by enzymes I mean we know that testosterone is going down my testosterone is actually quite low you know I'm sitting here kind of on the fence contemplating should I really start testosterone replacement therapy because my testosterone has kind of been in the crapper for a few years but I know me crap or what what number oh I sort of hover in the 400 nanogram per deciliter range and I've kind of been there for a few years and you've tried to elevate it naturally and can't um I mean only in that I'm doing all the right stuff like I sleep incredibly well but my FSH and LH are really at the upper end of normal in other words like everything from my brain is doing the right thing my brain is telling my body to make testosterone but you know I'm sort of at the limits of what my body's willing to make right now which is you know probably I'm at about the 20th percent tile now one time you and I had spoken about testosterone replacement therapy and you said you prefer to do precursors and not so would you still do the precursors if you do it I'd probably start with a precursor or a pre-hormone like HCG um I wouldn't use Clomid which is another one um and give it a shot and see if that could really wake things up but you know eventually you know I'd probably need testosterone um but even that like even if you restored my testosterone levels to what they were in my 18s or 20s I'm not sure that that would be remotely sufficient to address the metabolic changes that have occurred in me um you know I probably have less hormone sensitive lipase or or lipoprotein lipase rather on my muscle cells and more of it on my fat cells in other words my body is probably more inclined to fuel Partition unfavorably meaning it's probably more inclined to take energy and put it into fat cells as opposed to direct it towards muscle cells so all of that is to say there's no way today I could out exercise a bad diet and as a general rule again at least if using uh body composition is the metric yeah it's a pretty good um you know rule of thumb that you're not going to out exercise a bad diet but there are exceptions clearly okay so I want to linger on this idea for a second that because this the reason that I am really I've always steered myself towards things that you say is because you have a really deep ability to get to the mechanism of action and so this idea that a diet is incredibly important in terms of you have to do the right thing to avoid downside but it's not really going to elevate you now we hand over to exercise and exercise is potentially going to now pull you farther forward but I want to understand why so is it you talk a lot about in the book stability is it just that I'm not going to fall or is there something going on at the cellular level that becomes important it's all of the above so um you know generally speaking we think about this through the lens of Health span and lifespan so let's just start with the lifespan side of that and we can even go back and talk about the nutrition piece right so if your nutrition is sub-optimal what does that mean there are lots of ways your nutrition can be sub-optimal it can have too many calories in it it can have too few calories in it it can have too little protein in it it can have deficient micronutrients in it I mean those would kind of be some of the big examples of where nutrition can be off and those will produce different phenotypes you could be underweight you can be overweight you can be insulin resistant which comes hand in hand with excess nutrition you can be under muscled which would be a result of low protein intake so and then you can have a whole bunch of sort of deficiencies like B vitamin deficiencies and vitamin D all sorts of nutritional deficiencies that come from not getting the right vitamins and micronutrients on the exercise side we can go through the same exercise by the way on on the nutrition side that mostly impacts lifespan those deficiencies disproportionately Point towards a shorter lifespan so as you increase adiposity you increase meaning as you get fatter um you increase the odds that you're going to start spilling that excess fat from the safe place that you can store it which is in your subcutaneous fat cells as athletic as aesthetically unappealing as that is but otherwise metabolically quite inert you start spilling that into places where fat shouldn't be inside the liver inside the muscle itself meaning right inside the muscle cell around the pancreas around the heart around the kidneys around the organs itself is visceral fat once you start spilling fat there all of a sudden your risk of every disease every chronic disease goes up and it goes up a lot right I mean we're talking about a doubling of risk of cardiovascular disease cancer and neurodegenerative disease especially Alzheimer's disease don't pull past that so I need to understand this mechanism so it's um you're filling the fat cells you're also making new fat cells some not so much you basically I'm talking about when it's working well oh no no you're just filling the fat cells yep and the subcutaneous fat cells are accommodating the increase in energy storage so again even though you know culturally we don't like that that means you're getting fatter yeah evolutionarily that's an enormous leap step forward right this is what allowed us to basically develop monstrous brains is the ability to store lots of energy so we weren't dependent on meal to meal because our brain is by far the most energy hungry part of our body so you have this organ waste two percent of your body weight consumes 20 to 25 percent of your energy any interruption in energy is going to prevent the brain from working so in order to evolve very quickly and basically hit escape velocity on all other species this was our trick how could we become efficient at storing energy and fat is by far the most efficient way to store energy so this is all very good it only becomes problematic when you live in an environment where there is so much abundant energy that you exceed the capacity of this system to safely store it right so the way you can think of it I think I described it the way the book is a bathtub the bathtub that is your the total Depot of all your fat cells water is energy is flowing in there's a little drain that safely drains water out that's your expenditure of energy the balance between those two things determines the water level at some point if the input is so much greater than the output you will not only raise the level of water to the point where it's getting bigger you'll start to overflow it's that overflow that's destructive right right so does your body store visceral fat without overflow no visceral fat is part of the Overflow okay so is visceral fat made up of the same sacs that I would find in my subcutaneous fat um it's uh no it's it's actually kind of a different location altogether and it's it's it behaves very differently so visceral fat is far more inflammatory in fact that's part of the problem you know if we do a dexa scan on a person which is how you can measure some of this stuff you do a dexa scan on a person that weighs 200 pounds that has 25 body fat so by definition based on those numbers they have 50 pounds of fat but let's assume that of that 50 pounds of fat the visceral fat is five pounds so ten percent of their fat is visceral that five pounds of visceral fat is wreaking all the damage in their body the 45 pounds of fat that is not visceral totally inert okay let me describe it in a lay person's way so subcutaneous fat is water inside of a water balloon visceral fat is water on your sweatshirt yeah and your sweatshirt now is just [ __ ] wet and nasty yeah think about the bathtub analogy right the the subcutaneous fat is the water in the bathtub is totally fine the visceral fat or peripancreatic or intramuscular or intrapatic fat is when it gets out and starts leaking through your floor it's the same stuff it's the same just one is in its rifle container and the other it's just glommed on to something that's right that is really interesting so for example in the muscle what does that fat do that's so destructive it impairs the signal of insulin not to get terribly detailed but you like the mechanism right insulin hits a receptor called the insulin receptor that insulin receptor triggers a Cascade a chemical Cascade in a muscle cell that tells a glucose transporter to move up to the cell and allow glucose to come in that's the way it's supposed to work when you have fat inside the muscle cell that signal gets broken so that's what the that's the first sign of insulin resistance and the body says hey I need to get rid of this glucose I need to get this glucose into the muscle that's where we store glucose I can't I need more and more insulin to do this and eventually you run out of ways to do that so initially you can make the glucose go away but you need more insulin eventually all the insulin in the world doesn't do it the glucose goes up that's called type 2 diabetes okay so how do I overwhelm that system if I have a binge night on a Saturday and I'm going ham on the ice cream am I going to overwhelm the system or do I have to fill the fat cells first is it basically speed or quantity so two separate things there so if you're just having one binge night eating ice cream and stuff you're you're binging you know you've got glucose and fat and you may you may well dispose of those things fine it depends on your incoming state so if you're a relatively healthy person an insulin sensitive person a night of binging really isn't going to cause any trouble certainly nothing long term right what we're really talking about is The Chronic result of doing that and so the the glucose these and the fat piece are slightly different the the glucose piece is very tightly regulated um you know if you consider the difference between a person who doesn't have type 2 diabetes and someone who does it's literally only the difference of one teaspoon of sugar in the blood that's the I mean it's a remarkable difference in terms of how subtle it is that's how tightly the body wants to regulate glucose so when the body can't do when the body can't regulate glucose that becomes type 2 diabetes long before that's happened you've usually started exceeding your storage of fat and it's that excess fat that spills out of the bathtub that is making the body dysfunction around glucose regulation I've recently heard that it's more dangerous to be a lean diabetic than to be an obese diabetic do you agree with that the data absolutely suggests that that is the case okay so if I'm a lean diabetic then what that predicts is that my water balloons are very small and they just can't take much water and so they keep spilling back out spilling back out spilling back out so if I'm a lean diabetic I probably have a ton of fat around my viscera yeah and that doesn't translate to much weight on the scale because you don't need much of that visceral fat peripancreatic fat intra hepatic fat you don't need much of it in total mass to cause absolute metabolic destruction okay and so that's why the lean insulin resistant the lean person who's metabolically unhealthy has the worst outcome so interesting man so okay before reading your book I would have come in uh and said all right let me just look at the person I'll ballpark you if they are lean they're almost certainly fine and if they are obese they for sure no question they have a problem metabolic disorder they're in danger uh I get the feeling from reading your book while that may sometimes be correct and maybe directionally at the population level it's fine but that an individual actually can be fat and healthy and that a lean person can effectively have the blood if somebody is morbidly obese yeah you're absolutely right at the population level we can look at things like BMI and make General broad statements but at the individual level to do anything other than ask the question specifically about that person is to do a disservice and you're right up to a third of people who meet the BMI criteria for obesity they are metabolically healthy and their life expectancy is the same as a lean person Jesus okay so when I read that in your book I actually had this impulse I'm ashamed and I would never act on it but I had the mask mandate impulse of like you can't tell people that like you you're just better off telling them that being fat is going to kill you don't be fat well so this is where Nuance comes into uh consideration everything I just said is more about lifespan but let's talk about health span okay there are reasons to not be obese that go beyond you know premature cardiovascular disease cancer Etc think about the impact it has on joints so it's not necessarily going to shorten your life if you're metabolically healthy but there are still other consequences that's right got it okay joints just because I'm carrying so much weight yes every time you take a step while walking your knees are experiencing approximately three times your body weight in terms of force Jesus when you're running it's about eight times your body weight so losing weight has a very non-linear effect on your joints and similarly gaining weight in the negative Direction has a very non-linear effect on joints there's a reason that now I'm not that psyched about running the way I was when I was 25 pounds lighter I was 25 pounds lighter my joints handled it effortlessly today I don't know I'd probably get away with it but I'd have to really reduce my volume and frankly I just choose not to I much prefer to get my cardio doing things that aren't having impact on my joints what's up everybody Tom bilyu here and I am very excited to share some news with you that's going to help you be legendary in honor of mental health awareness month this may I'm teaming up with better help to bring you an exclusive video miniseries available only on Spotify every week in May I'll be sitting down with some of the most inspiring insightful people in the world of mental health and personal development we're talking about people like Mo Gadot and Emily Morse who will share their wisdom and strategies for overcoming challenges building resilience and tapping into your full potential each video will be packed with practical advice powerful insights and actionable steps you can take to transform your mindset and take back control of your life so if you're ready to take your mind and body to the next level tune into this all new mini series exclusively on spot modify sponsored by betterhelp check out betterhelp.com impact Theory to get 10 off your first month yeah we don't want to dismiss the orthopedic causes of you know reduced reduce more reduced Mobility um and weight plays an absolute role on that furthermore I don't want to suggest that body composition doesn't matter lean mass absolutely does matter and it's really what people should be focusing on so this gets back to the point of you know the reason I'm not a huge fan of sort of population-based metrics like BMI is they just don't contain enough information right like a very very muscular individual will could have a BMI of an obese person so obese is defined as a BMI of 20 a pardon me of 30 overweight is a BMI between 25 and 30 is overweight I think my BMI is like 28. so I'm I'm closer to obesity than normal weight but I'm not based on body composition yeah so body compositions we're really not watching he's he's got some muscle on him this kid no I mean I'm like just I'm a relatively normal healthy guy and that's what by what metric do you consider your physique normal like the normal person in America yeah maybe not maybe not heavy yeah sure um so anyway my point being when we look at our patients we I don't know my patients bmis I couldn't care less I want to know how much visceral fat they have I want to know how much total body fat they have I want to know their bone mineral density and the metric I probably care most about or at least as much as bone density and visceral fat is something called appendicular lean mass index and fat-free mass index what is that so appendicular lean mass index is take the total amount of muscle mass in both arms both legs in kilograms divide it by your height in meters squared you get a number that number we rank on a nomogram and we care what that percentile is why arms and legs arms and legs well we do too so you do appendicular lean mass index which is arm's legs and then we do fat free mass index which is all non-fat mass of the body and you do the same calculation each has a pro and con the fat free mass index has the advantage of including all the muscle in the body but unfortunately it includes stuff that's not muscle it includes organs the appendicular lean mass index has the advantage of being a very good proxy for muscle mass in those locations because they don't have organs in your arms and legs so we do both and they usually give concordant answers but sometimes they're a little discordant and we have to evaluate them discordant meaning they have different percentile predictions but we want to see people at or above the 75th percentile for those two muscle mass metrics and again you don't have to be super that doesn't mean you're super jacked right like you know a super jacked person is off the chart on those things but again no one would accuse me of being super jacked I think I'm at the 95th percentile so we're this is not a this is not a standard that is unreasonable and the reason we care about that is the the evidence that if you look at a person whose almi is greater than the 75th percentile that's one of the ones you're just describing that's the appendicular lean mass index and you compare them to people below the 75th percentile the mortality difference in those people once they reach their mid 70s is a staggering difference so in one study if you looked at people who were 75th percentile or higher their 10-year survival from the age of 72 was 80 percent if you looked at people who were below that their 10-year survival was 50 percent that's a pretty big difference when you take on a new client that is coming to you specifically for longevity reasons do you start with looking for signs of degradation the damage that they've done or are you prescribing the things that they ought to do no we start we want to we want to get as much Baseline information as possible so everything from your family history in excoriating detail because it's going to tell you about the what you call the horsemen in the book yeah what are your legion of death that's right what are your what are your risks at least as your genes would set us up to believe obviously lots of blood work body composition information functional testing so mitochondrial function VO2 max which is Peak aerobic strength and movement those are really big big buckets and we have very specific tests that we use for each of those things the strength and movement tests are tests we've designed over the past several years um and and they're I think in many ways some of our best work really because they're you know we had to come up with this stuff on our own because nobody else really had a test that we felt was as predictive of you know what we wanted to believe so it's doing a whole bunch of that type of testing and and using all of that to basically come up with something we called the longevity risk assessment the lra which is a rank order of all the things that are a threat to their longevity there's basically seven things that are a threat to how long you live and how well you live yeah and we just sort of rank them out and get to work and that's when you start to get to prescriptive what are the seven uh cardiovascular disease or the diseases of atherosclerosis so cardiovascular and cerebrovascular disease cancer neurodegenerative diseases inclusive of all dementias um accidental deaths including Automotive accident uh what do you look at for that fall risk as you get older yes so it's basically Falls automotive and overdose so that would by the way include people who are using illicit drugs right if you're using list of drugs nowadays there's a very good chance you're running the risk of getting spiked by fentanyl right last year over 100 000 people died by accidentally ingesting fentanyl because it's so cheap and so people are putting it into other drugs yeah basically drug cartels are now using synthetic fentanyl as a filler in drugs because it's insanely cheap okay um then you get into uh sort of physical decline so Orthopedic injury and physical Decline and then there's usually some special one that'll show up that's specific to an individual so for example you know someone might have hemochromatosis or something like that or something like that yeah just a genetic disorder of like iron uh metabolism or someone might have you know low kidney function or something like that once you kind of rank order those risks that's what determines the getting to work part so now you start to get prescriptive how do you go about mitigating those risks so then you'll take on a period of time what are the things that you start looking at so if I said hey I the person you want to talk to you can't ask them any questions but I can give you any reading you want would you go immediately there's seven things we look for in the blood or um yeah blood testing is very helpful but it has lots of blind spots there's no one test that offers us everything so blood testing for example will give us great insight into your risk of cardiovascular disease uh pretty good insight into your risk of dementia what are you looking for there I'm gonna guess glucose yep you're certainly looking for all things that pertain to metabolic Health all things that pertain to lipids and lipoproteins inflammation things like homocysteine what would you look for for inflammation C-reactive protein yeah c-rective protein interleukins things like that um you also look for again all the lipoproteins factor into both cardiovascular disease and dementia really fast I want to go back to inflammation this is the one that scares me the most when I was a kid you could write on my skin just by scratching me and it would welt up um I ice my wrist in fact this is where you and I first cross paths I was icing my wrist for 15 years you had me try keto which will definitely talk about your change of perspective on that uh that changed my life and by introducing healthy fats my inflammation plummeted but I still I've not ever done a C-reactive protein test if you see C-reactive protein in the blood do you know that oh that's coming from or is it just like okay it's very non-specific yeah yeah so very very high levels of C-reactive protein which we often see almost assuredly don't constitute pathology of concern it's usually an acute illness really yeah so normalcy record protein level is less than one if if I get a patient's blood back and it's 12 I'm calling them and I'm saying hey were you sick around the time we do this blood and they're almost always saying no but I got sick the next day or yeah I'm just I was just coming off a bad cold so somebody on a standard American diet won't have spikes not not to that high usually what I'm more concerned with is the person who's got a C-reactive protein of two and a half that never goes away there's something going on there and it could be diet related it could be autoimmune it could be cardiovascular it's very difficult to know so again the problem with most of the biomarkers around inflammation is the profound non-uh specificity of them when did your uh so if my arrogance around diet started to dwindle uh with your book when when did your conviction around diet is is going to be the answer to everything when did what what began to shake that I think just kind of in the process of writing this book and getting deeper and deeper into the data I don't know tooth Circa 2011 to 2012 where I even went on a whole rant about the non-importance of exercise relative to nutrition and by the way I acknowledge up front the irony of me writing this because this was still back in the days when I was exercising three or four hours a day but I sort of chalk that up to look I have an addiction and I do this and I love it and it's like a hobby it's like a passion like I would do this if it were harmful but like don't look at me and think you need to be doing this right all you need to be doing is you know controlling your diet um so so it just became impossible for me to ignore the the literature on exercise and what what's the thing like you saw grip strength is tied to a massive decrease in all-cause mortality stuff like that like what are the biggest it's the entire spectrum of it right so it's the experimental literature the epidemiologic literature the mechanistic literature but what's it all saying Muscle Matters like if we had I know you [ __ ] hate the I did this whole note-taking session about how you hate like people that don't get into the nuance and then I was like my Counterpoint to that is if you can't distill this stuff no look I would say high cardiorespiratory Fitness and high muscle mass and strength are more predictive of a long life than anything else we know say those again High cardio respiratory Fitness yes it's measured by VO2 max okay High muscle mass high strength the amount of muscle the amount of muscle although I would argue it's more strength and we just see a very tight correlation between strength and muscle mass okay within reason interesting that is more predictive of a long life than any other metric we have okay so now we're going to get to I'm going to test this at the fringes I don't know if you know who Dr William Lee is but I just had him on the show and I was barraging him with questions about sumo wrestlers and he made an assertion that I found just impossible to wrap my head around which is that a Sumer wrestler may be perfectly healthy and I was just like how the [ __ ] is that what that tells me is that I could ask you and get a prescriptive answer to the question how do I get obese in a healthy fashion so I can't speak to sumo wrestlers I don't understand anything about them I don't know but but on its face it's possible Right In based on what we just talked about they can as long as they're hella strong as long well no as long as they are metabolically healthy in their obesity there's no question okay consumer wrestler is profoundly obese right and it's not like just muscle mass so a sumo wrestler is extremely high in muscle mass is extremely high in strength is also extremely high in fat if they also happen to have high cardio respiratory Fitness which I'm guessing they do to do what they do provided all that extra fat isn't creating a metabolic problem okay let's let's define that so they're not leaking out so they don't have they don't have insulin resistance they're able to uptake their diapers of glucose just fine they're um and the reason that matters so much is because if you don't you're getting uh the so two-ish glucose is sticking to things yes so that's that's half of the equation so half of the damage this is a bit of an oversimplification but half of the damage is the excess glucose is causing a lot of sticking around and it's damaging small blood vessels the other half of the problem may be even a bigger half of the problem is the excess insulin that is trying to put that glucose away is causing damage to larger blood vessels and also it's a growth factor that is constantly in the on switch feeding tumors cancer would certainly be the biggest concern you would have there and that's probably why after smoking obesity is the second most prevalent environmental trigger of cancer because obesity is a signal that you've got your body in grow grow mode well obesity is often though not always accompanied by high signals of growth and inflammation which gets back to you know are you a metabolically healthy or unhealthy obese person if you're metabolically unhealthy and obese that means it's by definition accompanied by high growth factor High inflammation high glucose and all of those things are destructive to your health so is the fat becoming inflammatory because it sends out a hormonal signal or it sends out inflammatory signals when it's not in the fat cell when it's not in the right fat cell when it's not in the subcutaneous fat cell got it so those visceral those fat droplets that are around the organs are sending out inflammatory signals so when we're looking at an obese person just to beat this point to death really the we're just concerned about I'm going to guess given that you're obese so you're probably leaking fat into the system that is becoming visceral fat which is just loose using the water balloon analogy it's just loose fat and sticking to things that it's not supposed to causing distress and the liver I know can cause scarring absolutely causing damage in the liver then yes can absolutely lead to scarring and ultimately cirrhosis if it doesn't goes or go away which is the leading cause of liver transplantation is fat accumulation in the liver not related to alcohol ingestion yeah um and getting into the pancreas poisoning the beta cells making it harder for them to even make insulin so further exacerbating the problem of high levels of glucose um so yeah but the problem is when you're looking at that person with your naked eye you don't really know it okay very interesting all right so back to strength um getting back to our sumo wrestler so we we would have to look for things to see if this is fat in a healthy way and it oh can I say protective instead of healthy sure maybe I just have something emotional I still need to work through with obesity uh but it feels like uh the reason that a lean diabetic is in a far more problematic state is it does not have the defensive mechanism of hey this terrible diet that you're eating is causing the leakage of fat uh and when you're obese it's like hey we got you you can pump the system full of fat we can store it appropriately all as well so the Obesity then to a point will be protective it seems that obesity to a point is the safest place to put excess energy which you're better off not consuming yes but if you are consuming it you're way better off storing it in subcutaneous fat cells and getting bigger than you are just letting it dissipate into in other words you're better off having a bigger bathtub that's full than having a smaller bathtub that's draining water onto your floor and down your heat ducts okay let me ask you another question while I get as we age we're probably not going to be able to do it is there any damage being accumulated to a Michael Phelps in his early 20s eating 10 000 calories but burning 10 000 calories through exercise yeah great question um probably not in the short run um and probably not if upon ceasing all of that activity the energy expenditure returns back to an appropriate level so as long as the body's using it you're fine yeah now again um there might be a behavioral challenge there it might not be an accident that a lot of former athletes who are you know basically eating as much as is humanly possible to support their energetic needs when they're young struggle to maintain Health when they get older because the habit of still I mean I truthfully Tom I think I still struggle with this like I mean I'm not in a position now where I can just eat all the time and yet I think there's a part of me that's still kind of wired to want to right but again when you're not exercising six hours a day you can't so and I remember you know even when I was young my parents just watching with complete befuddlement as I would I was just constantly eating and it didn't like I would tear through ice cream I was just always like it didn't matter it just didn't matter I was an eating machine and it was freakish for people to watch they couldn't believe it and yet I was rail lean right and they said I remember my parents saying is like you know they're like you better be careful like one day you're not going to be able to eat like this um yeah that is uh the Lamentations of the old looking at the Young yeah no I definitely get it uh okay so if you maybe the data already shows us but if you had to guess or base it on the data why is why does strength matter so much is it that cardio Fitness uh means your heartbeat slower when you're not exercising and and the differential between how much you exercise and thus speed it up but that the amount of time you spend in that really slow resting heart rate like that's the deal is it um you're gonna say all the above but like grip string so I'm not falling uh I don't know what else well I'm storing amino acids in muscle yeah so I think there's several things going on so let's talk about the limitations of the exercise so the limitations of the data are your their data are only as good as things that we can measure so you know what hemoglobin A1c is yes okay so hemoglobin A1C for people listening is a blood test you get that in a snapshot gives some prediction over what your blood glucose has been doing for the past few months so in that sense it's what is called an integrator right if you think back to calculus for people who took calculus the integral is the area under the curve it's the total ups and downs it incorporates everything that's happened and so in this case hemoglobin A1c is an integral function of the last three months of your eating at least as it pertains to glucose doesn't tell you anything about fat protein overall calories doesn't tell you any of that stuff but gives you a pretty good indication of how your body regulated glucose okay integral functions are not common in biology unfortunately uh I had a recently a very interesting guest on my podcast and we talked about how HDL cholesterol may be an integral function for recent triglyceride levels so the fluctuations in your triglycerides and we know that lower is definitely better becomes an inverse correlate with HDL cholesterol so the higher your ratio cholesterol might suggest lower previous levels of triglycerides so that's kind of interesting that has not been validated but it's an interesting hypothesis but for the most part we just don't get great integral functions it turns out VO2 max is a really good integral function of how much cardio training you do um so VO2 max have you ever had a test done I have not but do you know how it works uh I think so so you run uh all out and then you go slow get your heart rate back to 100 run all out again well that's how you would train for it but the test is done uh on either on a treadmill or a bike those are pretty much the only two ways to do it you have a mask on and you're pushed so you get a warm up and stuff but then you're basically pushed until you fail where you're like I have to jump off the treadmill yes got it um and what's hap what they're sprinting so they're trying to no no no it's not it's it's um at the end it feels like you're sprinting but they'll you know if your two Max test might take 10 minutes they're gradually working you up and watching your consumption of oxygen rise so this mask is measuring how much oxygen you consume because it has a little oxygen sensor on it so it knows the flow rate of oxygen that you're putting in and it's measuring the concentration coming out and it's it says okay right now you're consuming one liter of oxygen so you and I sitting here right now are consuming three or four hundred milliliters of oxygen per minute very little if pushed to your max you might be 10 times that whoa the fittest athletes in the world you know will get to 20 times that at they have the capacity to use so much oxygen so that's what the VO2 max test is it is measuring your maximum consumption of oxygen the higher that level the longer you're going to live there is no number there is no biomarker there's no finding in all of biology that is more predictive of a person's length of life than that specific number and the question is why and I believe the reason is VO2 max is such a potent integrator for what you have to do to have that number you aren't born with that number being high there's clearly a genetic component to that number you know the the highest people in the world ever measured are born with a great potential for it but they won't get that potential without training and the training you have to do to get that is pretty hard so what the what this tells you is that that type of training is what's really valuable the same is true with strength when you compare very strong people to very weak people you see almost as high a prediction of longevity as you do with high VO2 max to low VO2 max and again it's important that we are strong for all the reasons you said it helps you prevent falling it helps you stand up it helps you do all of these things that matter but I think the reason it's telling us you're also going to live a long time is because it tells us what you had to do to get there when we see that the top 10 percent of people with grip strength compared to the bottom 10 of people with grip strength have a 70 percent less chance of getting Alzheimer's disease and a 70 chance of dying from Alzheimer's disease it's not because grip strength by itself protects your brain right it's because those people by definition are doing so much more physically and it's the doing part that is protecting their brain man this is uh very interesting so let uh I'm gonna ask it so let's imagine a world where we have uh just insane AI with VR do you think that I would be able to stimulate my brain in a way that because people talk about for staving off dementia like dancing is nothing anything so can I obfuscate the need for the physical part if I'm stimulating the brain or is it like nope like you're not doing the things you would need to do to make your heart uh and again I don't know if it's resting heart rate becomes the thing that's good or because if it really is just the thing you have to do and not the outcome of the thing right right uh how can I fake it uh probably you would get some benefit in a if you did this as a thought experiment where let's assume we can truly above your neck replicate The Experience that's probably giving you some of the benefit but I don't think it's giving you the majority of the benefits so the muscle acts like an endocrine organ so when it is put under the appropriate stress it is releasing myokines right it is releasing hormones that are having a beneficial value for example bdnf brain derived neurotropic factor is being released and providing effectively nutrition to neurons so you actually have to do the thing to get it not just thinking you're doing the thing also let's not forget all of the other benefits of exercise such as the metabolic benefits so we talked about all of this business around insulin resistance well the number one cure for insulin resistance is exercise that's why those sumo wrestlers can be morbidly obese by most definitions and still potentially be quite insulin sensitive because of how active they are and then of course we get into the structural piece of this right which is what good is it to have a brain that works if your body actually does not yeah or vice versa yep for that matter uh okay so ketogenics was something it really was transformational and as I discovered ketogenics through you I'm very curious to hear um you no longer feel the same that you did what changed well it's a broader topic I think around that of dietary restriction so I think my aperture has just widened significantly so you have to take a step way back and ask the question how does one what are the ways in which one can change their diet so let's come back to your example in a moment because I think if I recall when you went on a ketogenic diet it wasn't in an effort to lose weight no yeah so let's put your case aside for a moment and instead discuss it through the lens of how most people think about ketogenic diets vegan diets pick your diets it's it's usually some form of energy restriction so I think initially I was like most people are pretty myopic about my views of energy restriction and over time that thinking evolved into saying look there are really broadly speaking three strategies to reduce intake one strategy is to just directly fixate on the reduction of energy intake that's called caloric restriction so bodybuilders are a great example of this right like they really know how to weigh and measure every single thing they're eating and they certainly understand during an anabolic phase this is how much energy I need during a catabolic phase or cutting phase I need this much and they've got this down to a science and it's really remarkable I mean it's a science optimized for the reduction of fat that's right that's right and maintenance of muscle that's exactly right so longevity that's right absolutely right so so but but let's be clear like I don't think there's a better example of any type of person on the planet that's figured out how to control intake up and down and to produce a perfect result with respect to that aesthetic well said and for most people that's really hard to do um it's hard to do because you can't really ignore it like you can't just eat without thinking you always have to be paying attention to what you're doing but it is the most direct way to go about getting the results you want so that's method one method two says how about I don't pay attention to what I'm eating or when I'm eating um but I pay attention apparently I don't pay attention to what I'm eating or how much I'm eating but I just pay attention to when I eat so that's called time restriction people call that intermittent fasting and if I make the window in which I eat small enough I will reduce energy and take in total so if I said to you you know you can only have one meal a day chances are you are going to lose weight now people thought that well there must be something magical about intermittent fasting beyond the caloric reduction but that turns out to not be the case it's been tested in several studies now and it's clear that if you eat 2 000 calories in one sitting it's no better or worse for you at least from a weight perspective than if you eat 2 000 calories spread out of the course of a day it's probably worse for you in another way though which is you're a little more likely to lose muscle mass because you won't be able to get the right amount of amino acids I don't want to derail your point but we are going to have to talk about autophagy because I intermittent fast like a fiend great 365. yeah okay so then we get to the third method of caloric reduction which is the use of what's called dietary restriction so here we pick things within the diet and we cut them out and the more restrictive that is the more likely it is to produce an energy reduction and therefore the more likely you are to achieve the goal of weight loss so the glib example I always give is if you went on the no lettuce diet you would not lose an ounce right right it's simply not restrictive enough if you went on the only potato diet you would lose an insane amount of weight you simply couldn't eat enough potatoes to maintain now the that's not a healthy diet right no one would think that the all potato diet is going to produce an ideal Health outcome but you will lose a lot of weight right so keto is simply a very for a restrictive form of that diet and many people lose a lot of weight on a ketogenic diet because they are limiting so many things right they're limiting so many carbs it's also for many people much more satiating so it actually readily reduces their hunger and so they simply don't want to eat more so they have fewer food choices and they don't want to eat as much but you can gain weight on a ketogenic diet if you eat a lot you have to be careful because you're generally eating more energy dense foods on a ketogenic diet and I've seen lots of people blow up on ketogenic diets because they somehow think it's a license to eat as much fat as they want not the case so now let's talk about so so that's that sort of coming to that conclusion made me realize oh well there's nothing really magical about any particular diet when it comes to energy balance but now each of these diets has their own trade-offs around other metrics of Health so for example we talked about the importance of protein protein is I think the most important of the macronutrients I know everybody wants to argue about fat and carbs but I think the the game is won and lost with protein and you know the recommended dietary allowance of protein is unfortunately very low so there's most people are being told to eat 0.8 grams per kilogram of body weight and that's literally half what you need to be eating whoa yeah that's the amount of report for body mass that I carry or ideal body mass total body weight yeah so if I at six foot weighed 250 pounds I'm going to be wanting to eat something like 1.6 X that in protein in kilograms so yeah so if you were if you weighed if you were whatever 200 pounds I would want you consuming at least 160 grams of protein and maybe closer to 200 depending on your demand and depending on your age and depending on the type of protein you're getting so a lot of different diets let's pick two that I think one has to be they're doable but you have to be careful about getting enough protein so let's start with a plant-based diet so plant-based diet by definition you can't have any animal protein so all of a sudden you're doing away with the best form of amino acids you know one could argue that when we eat animals or animal protein it is a more pure synthesis of the amino acids that are coming from Plants right so like a cow all it's eating is plant but you eat a cow or like venison is one of my favorite things right so I'm eating wild venison from Hawaii that only eats grass and yet it's the richest source of amino acids I can sink my teeth into in other words its digestive system its metabolism is doing this remarkable thing I can't do which is turning grass into the richest densest source of protein if I want to go back and eat the grass it's fine but I just have to acknowledge I'm gonna have to eat a lot more of it because it's not a great source of protein so the bioavailability of plant protein is about 70 percent that of a animal protein and it's not as rich in the most important amino acids so when we have patients who are plant-based and they say oh do I have to give up my plant-based diet I say not necessarily um and if it's working for you in all other ways other than this then there's a work around here but the workaround requires you being very deliberate about your protein quantity another example is you so we're going to come back to the case that you just said which is what about people who are intermittently fasting do they have to you know is that a bad thing is it a good thing well it depends but if a person is intermittently fasting you're going to see a lot of muscle loss unless they're very thoughtful about their protein intake so it you know if a person's intermittently fasting 16-8 you can generally get away with it because in eight hours you can get usually at least three good servings of protein but we have a lot of people who are intermittently fasting and they're only eating two meals no snacks they can't come close to getting the right amount of protein in because you can't have let's just say you're on the 160 gram a day program 80 grams twice in your day is not going to cut it because you can't put 80 grams to work it's too much protein for the body to utilize Peter man this is so different than how I live well nobody think about it like bodybuilders are very thoughtful of this right if you look at bodybuilders I thought we debunked all the like six meals a day and you're saying no like I actually do need to break it back up if you're optimizing for muscle mass yes and it can't be too small so this is where it gets really crazy if you're eating really small amounts of protein yes like 20 grams at a time you're not going to get muscle protein synthesis because the liver is going to the liver basically takes first dibs on the protein and undergoes gluconeogenesis it's just going to make glucose out of protein so if you just trickle tiny amounts of protein in you're not getting muscle protein synthesis I'm turning it into glucose it's a really inefficient process yeah you're just the liver is turning it into glucose if you eat tons of protein and the limit based on a literature seems to be somewhere between 40 and 50 grams in one sitting okay once you exceed 40 to 50 grams in one sitting the excess just goes into gluconeogenesis huh wow okay this is very fast so if you're trying to get 140 grams a day you really need to optimize it by 4 times 40. and ah wow okay so amazing this is amazing I'm always game to change uh okay so I'm breaking my protein up 4 by 40 if 160 is my goal what period of time do I need to put between them because I would be happy to do that like it what's your feeding window what do you like to eat when to win man I I usually keep it tight like four or five hours max okay so if you really want to do it that way then you're going to have to have well I don't want to do it that way if I need to well but but I'm saying like if that's working for you from a weight management standpoint and a total calorie I'm a freak of discipline I will never accidentally gain weight you don't have to worry about that with me what you have to worry about with me is right now I believe that autophagy is necessary to avoid cancer I don't want to die of cancer so I intermittent fast to make sure that I'm in autophagy but there's no evidence that 20 hours of fasting is sufficient to induce autophagy yeah see I thought there was man I thought autophagy kicked in at like 15 16 hours but mice will die in three days of not eating well that's bad yeah so in other words like we're just it's apples to oranges we have no I mean do we know where it kicks in for humans no because we don't have biomarkers for autophagy my intuition which might be as useful as a warm bucket of hamster vomit is that it's probably three to five days three to four days maybe do you do any prolonged fasting I don't anymore wow um and I'm not opposed to it like I would probably still do you know if you were diagnosed with cancer what would you do yeah I would probably get back to fasting more evidence-based or just throwing everything at it mechanistic yeah give me the mechanism uh you know you get a perfect deprivation of growth factors yeah very interesting also selective sensitization of cancer versus non-cancer cells during chemo right so there is some evidence from Walter Longo's work that when you're undergoing chemotherapy doing so in a caloric deficit can be beneficial because the cancer cell is differentially and disproportionately stressed by caloric restriction and then the normal cell and therefore you're because remember chemo like the magic of chemo is not that it kills cells or kills cancer cells it's that it selectively kills cancer cells anything can kill a cancer cell it's how do you kill a cancer cell and not a regular cell right so how do you how do you enhance the spread between those two and it might be the caloric restriction is a way to do it and it renders the cancer cell even more susceptible and at the same time that you're hitting it with chemo it becomes uh more likely to die at the expense of the healthy cell that's that's the mechanism and there is some data to suggest that that's the case okay so uh autophagy we know is going to kick in at much longer we hope is kicking in it much longer periods uh deprivation can still help with cancer from a growth factor remember you're also kick an autophagy with exercise so if you're looking for another absolutely what is autophagy right autophagy eating well yes yes yes but what it's occurring in nutrient absence and there's a great way to induce cellular energy reduction which is exercise when you exercise cellular energy goes down that's why exercise increases amp kinase activity just as fasting does hmm so you you don't want to underestimate the benefit of exercise in tricking the cell into thinking its nutrients or scarce okay then what kind of exercise I'm gonna guess it has to be the kind that I hate the most and if VO2 max is the under the curve revealer uh it's what we're talking about very high intensity period of rice high intensity well that's how you train VO2 max but that's not what I have to do no because that's only that's that should only be 20 of your cardio volume eighty percent of your cardio volume Should Be steady state and moderate okay the 80 I like that a lot better interesting that's zone two as we call it yeah yeah and that's done at a level where you could carry out a conversation if you had to but you don't want to right that's the that's the litmus test that is a perfect description okay so uh going back to protein so maybe in fact no you're you're saying just flat out the intermittent fasting is probably not helping you at all and if anything it's probably making it hard for you to get protein and spare your muscle uh you need to spread this out you've spoken kilograms which really threw me off that's okay how much do you weigh in pounds uh 185 Okay so 160 to 180 grams per day so four meals at 40 to 45 grams is perfect for you okay spread out over ideally as long as possible and to be clear these don't have to be meals like two of my four 25 grams of protein that's a [ __ ] meal it's not though think about it like what is that 200 calories it's like a chicken breast it's yeah that I mean you don't consider that a meal that's a rounding error um no for me like I'm doing I'll do like I have these venison sticks that are 10 like little jerky Venice hot or made uh they're actually now bought you can now buy them I like that yep okay um so each one is 10 grams of protein and 50 calories and I will have five of those as a snack there's 50 grams of protein right there with 250 calories like it's nothing okay what about are they highly processed anything to avoid there no problem because there's a company they're made by company that I'm involved in so I mean I love the most obviously as a guy that only gets involved with things that I care about I think are real so it's called Maui Nui venison okay these are um this is a type of deer called Axis deer that are invasive to the state of Hawaii and so they're harvested there in the most Humane manner fashionable which is what allows the animal to be completely stress-free so they're harvested by sniper at night under night vision and whoa yeah so if you think about it like harvesting an animal is a very stressful thing for an animal like if you're thinking about how a cow is harvested yeah even if it has the most um Wonderful Life you know it's grass-fed it's out in the pasture it's not inside like all of that might be great and it is certainly better than the alternative but the very end of its life is still quite stressful this is a moral thing or does this moral no I believe I believe I believe it impacts the quality of the meat the interest right so think about the cortisol levels that are surging through that animal's body right at the time of its death yeah but from an evolutionary standpoint everything got eaten oh yes no no I'm not that's not a moral question I'm saying from a health perspective yeah but I'm saying you're a lion the gazelle you're chewing on is freaking the [ __ ] out as you eat it alive so there's no way that I can have some major no I think deleteriously it actually probably has an impact on taste more than anything else um the other thing is it's very hard I mean this is more of an argument of why I love Wild game yeah is Wild game eats the best plants the best feed right so when you go to the grocery store and you're buying you know irregular grain-fed steak it's not eating what it evolved to eat like it's you kind of want things that are as close to eating what they evolve to eat and you know for for deer that's like that's basically grass right so um anyway these things are processed in a way that basically has nothing in them right so you're just I'm just getting pure protein yeah I don't want to derail us but this is really interesting so you snipe the deer at night using night vision goggles so it basically dies in its sleep it dies instantaneously dies instantaneously stress-free um and so interesting how'd you find out about these guys um I met the founder of the company five six years ago um and we just immediately became friends I became completely fascinated by the problem that they were trying to solve which was how you know the Hawaiian government is trying to eradicate this species because it is destroying the island so this is a species of deer that was brought to Hawaii in the 1950s for hunting but it had no predator it was brought from India where its only Predator was the tiger you brought it to Hawaii it had no predator and it has now run amok so it is kind of destroying three islands of Hawaii finding a way to do this sustainably now so that they can keep having them the goal is by 2030 to have it be sustainable right now they are still not able to do it sustainably in other words right now the deer are still growing at a rate that is too significant Jesus uh headshots yes interesting wow I don't know why I find that so fascinating but that's very interesting okay so back to protein intake right so point is you could have a weighted wake up I'm like Chomp Chomp into the event not necessarily like I mean again it depends on when you like to exercise for example so so I should exercise fasted um it depends if I'm gonna exercise first thing in the morning I do it fasted if I'm gonna wait a couple of hours I'll have a protein meal first but it doesn't matter because I've always heard that you've got so much glucose if you're eating and now you're just going to get fat and you're never gonna lose it it doesn't matter no so so um I generally prefer to exercise fasted but if the workout is getting pushed till later a couple hours later I'm gonna have something before not because I need to but because I want to make sure I spread out those protein servings enough so at least two of my protein servings aren't meals they're like again the jerky is not a meal it's a snack and then like a whey protein shake again 40 50 grams of whey protein in some you know would you uh I'm willing to stomach the venison snacks and or chicken breasts and or eggs eggs yep great cool love them uh so if I'm willing to eat the amount of protein that I need in eggs venison whatever would I still do a protein shake not necessarily no not at all and do you because I have developed slowly over time a deep aversion to anything that's processed so I'm trying to get as close to biting in that's fantastic the walking animal as possible absolutely yeah that's great and then you would have like kind of two meals right so I'll probably also have like my lunch would be a salad with chicken breast or salmon and then my dinner dinner's the easiest meal to hit your protein Target right like that's like falling off a log just because it's typical to eat at a station or whatever whatever you're gonna have talk to me red meat white meat again I think it matters less the color of the meat matters much more the source of the meat matters much more about how that is a grass-fed grain fed yeah and and how close can you get it to an animal that's in its natural state truthfully it's much easier for me to get wild game that's red meat like I much prefer elk and axis deer both Wild game that either I'm killing or someone I know is killing and it's the wild that's the important part yeah it's an animal that's eating in the environment it's it's an animal that's not contained right and the contained is problematic largely because of the diet that we know they will need yep okay uh how much meat how much of your protein comes from meat by percentage um I don't know I'd have to figure it out but clearly the majority because the one thing I've I also like Greek yogurt by the way so that's another thing that's a hard left so Greek yogurt has a lot of protein it does actually it's quite high protein eat it because of the taste probiotics just another way to get protein in to diversify a little bit from boredom or diversity matters yeah just some diver no no just for me diversity matters like I like to mix things up and and it's just again it's just a function of time like maybe I don't have time to make an omelette right now and I'm I got a quick call I gotta jump on so I can scarf down a bowl of Greek yogurt with some nuts in it this seems impossible it does take for good no it sounds amazing like I feel like the way that I live right now would take a lot more discipline than what you're describing I'll be interested to see if that's true in practice um Okay so let's fit eggs into the mix here uh I'd love to get an idea knowing that individual there's a lot of individual variability here in fact we should probably talk about saturated fat at the individual level the one thing in my diet I do not at all pay attention to how much saturated fat I eat I'll go out of my way to consume it but I make zero attempt to avoid it and because I don't check my blood levels nearly enough I am always a little hesitant to push my exact diet onto people um do I need to worry about saturated fat potentially yeah um saturated fat can increase your uh synthesis of cholesterol it can also with enough of it being consumed the liver can sense the amount of saturated fat and basically shut down the clearance of cholesterol meaning the the bringing of cholesterol into the liver can I quote Peter attia on cholesterol in the book out live if you haven't read it I highly suggest it he said your total cholesterol number is about as meaningful to dying from heart disease is your eye color that's right so you're bringing up cholesterol so some something matters something about cholesterol matters but not the total number right total cholesterol is again not a particularly relevant number APO B which is the constant which is a measurement a laboratory measurement that is the concentration of lipoproteins that carry cholesterol into arteries that's what you should care deeply about but when someone says what's your total cholesterol 200 milligrams per deciliter who cares doesn't mean anything but there is a type of cholesterol that is carried in a certain well so cholesterol for the most part that 200 milligrams per deciliter is your total cholesterol is divided into three types of lipoproteins a high dose has a different carrier uh no that 200 comes is the aggregation of approximately three lipoproteins high density lipoprotein low density lipoprotein and very low density lipoprotein so if you look at your lab you get you get a blood test done if it's done correctly a lot of them are not but if it's done correctly and they do a direct measurement of LDL cholesterol you will be able to add up the vldl cholesterol the LDL cholesterol the HDL cholesterol and the sum of those three will equal to total cholesterol so if the total cholesterol is 200 and the HDL cholesterol is 70 and the vldl cholesterol is 20 the LDL cholesterol will be 110 yep and of those three numbers um we would say the most important Insight you could get would be to take total cholesterol subtract HDL cholesterol and that number is called non-hdl cholesterol that number starts to become a pretty good predictor of risk so total cholesterol because those are damaging in some way yeah that's now telling you the total cholesterol content of LDL and vldl and those are the destructive lipoproteins now an even better number is not how much cholesterol is contained in those two things but how many of those two things do you have and that's what's captured by apob can you explain that more so each of those lipoproteins the vldl and the LDL have a protein wrapped around them that protein is called apolipoprotein B100 which is a very sexy name it's abbreviated apobee so if you measure APO B Because LDL and vldl have one and only one April lipoprotein B100 on them the APO B number is the concentration of those two particles and the gradient of that the more of those particles you have the increase the greater the probability that those particles are getting into your artery walls got it so the the number of those do matter and so if I just subtract out my HDL subtract your HDL from your total cholesterol you get the cholesterol concentration of those two particles but I'm but and that's predictive of risk but what's more predictive of risk is the number of those particles okay which is how do you I don't know if it's going to be fruitful but there's something in that math that I'm not following so if I got back my cholesterol account and I look at them I'd be able to tell of my 200 let's say uh 110 are the two that are bad uh but there's some total number it sounds like it's a separate measurement you don't you wouldn't impute it from the those clothes you just have to go to apob you have to get the APO B measured that's right yeah it's another laboratory measurement understood understood because unfortunately rarely done is it can you just ask your doctor give me an apob measurement absolutely okay it's a relatively inexpensive test it's about people depending on the test it's somewhere between five and twenty dollars do they not do it because they disagree with you or they just don't know they don't know what it is troubling very okay uh so in fact we should talk at least briefly about this idea so in the book you talk about medicine 3.0 versus medicine 2.0 medicine 2.0 is all about curing medicine 3.0 is all about prevention um how do I would call medicine 2.0 more about treating than curing okay fair it's largely not Curative right very good distinction uh okay so if you were going to give me the um the little tool kit of medicine 3.0 uh uh what how would you begin to bundle that like what are the the things that I should be going towards well again to your point so medicine 3.0 really says we've reached the limits of what medicine 2.0 is good for medicine 2.0 is really good at curing uh acute problems so it's really good at curing um infections traumas acute issues it's really bad at treating chronic problems cancer uh you know recurrent heart disease neurodegenerative disease type 2 diabetes it's really bad at treating those things and therefore all it really does is prolong the period of time you have those things and I go through a lot of explanation in the book as to why that strategy is not the right strategy so living longer is not accomplished by living longer with a disease living longer is accomplished by living longer without disease once you realize that you inevitably come to the obvious conclusion that a new type of medicine is needed which must be focused on extending the period of time you do not have disease and that word is prevention which has been bastardized to mean virtually nothing because everybody talks about prevention but it has no meaning right so true prevention has to start very early true prevention needs a set of tools that medicine 2.0 doesn't participate in medicine 2.0 which is the medical system that every one of us who's trained goes through is largely A pharmacologic playbook if your mission is achieving Excellence you must support your body introducing ag-1 this Powerhouse blend is packed with 75 premium vitamins minerals and Whole Food sourced ingredients that elevate your immune system uplift your mood and promote restful sleep and athletic greens is offering our listeners a free one year supply of vitamin D and five free travel packs with your first purchase don't miss this opportunity to optimize your health and truly be legendary now you're going to get people who sit here and say our all pharmacology is Bad Medicine is bad no no that's not true at all pharmacology is wonderful pharmacology has done amazing things in medicine 2.0 and we would want to use all of those pharmacologic tools as needed in medicine 3.0 but it's literally you know one-fifth of the equation where is nutrition where is exercise where is sleep where is emotional health those things are also needed to delay the onset of chronic disease and none of us got trained in those tools so if if a doctor is going to help their patient with those other four tools they're going to have to learn about it outside of Medical Training that makes sense uh okay so if we know what we're trying to do is delay the onset of these disease you talk about that in the book that basically the thing that centenarians have in common is that they probably were able to delay the arrival of heart disease dementia uh because you say this cancer that these things are Bill building for oftentimes decades that you can see heart disease in teenagers which is pretty crazy so these are people that have probably delayed the onset of the early symptoms of that for decades more than the people that died I'd say 70 or 80. exactly okay that makes sense so now then I want to get to and we'll stay on cholesterol here for a second so you talk about in the book that dietary cholesterol does not equal cholesterol in your body so what does what causes bad cholesterol being the thing that I'm certainly more concerned about so dietary cholesterol is very difficult for our body to absorb it has a bulky chemical side chain on it called an ester and the only way we could absorb it is if we have an enzyme to cut the Ester off called the diastarified and bring it in we don't have much of that enzyme so most of the cholesterol you eat such as the cholesterol in you know shellfish or eggs you poop out okay so we should just make sure everybody understands that eating cholesterol has almost zero bearing on your cholesterol levels in your blood that doesn't mean that your diet has no bearing on the cholesterol in your blood but your genes play a very significant role in the levels of your blood lipids so we want to always differentiate between cholesterol and lipoproteins cholesterol is the cargo lipoproteins are the boat so um the term bad cholesterol doesn't actually mean anything people say LDL is the bad cholesterol that's actually very inaccurate right LDL low density lipoprotein is the boat that carries cholesterol and LDL is bad but we should really say LDL is the bad lipoprotein the cholesterol in LDL is the same cholesterol in HDL which people call good cholesterol so you can see why it doesn't make any sense now every cell in your body makes cholesterol so 95 percent of the cholesterol in your body is cholesterol you made the reason every cell in your body makes cholesterol is because it is one of the most important molecules in the body if you couldn't make cholesterol you would have died in utero and the reason for it is every cell in your body is wrapped in a membrane and that membrane is made of cholesterol most of the um important hormones in your body testosterone estrogen progesterone cortisol are made from cholesterol so this hormone is absolutely this molecule is essential for life but not every cell can make enough of it so we have to be able to traffic it between cells so we have to be able to take it back to the liver the liver has to be able to package it back out it has to be able to move around the system so if your body is like a big city the Super Highway of that body is the blood the circulatory system and the circulatory system is made of water so when you cut yourself you know you see red stuff come out but don't let the hemoglobin and platelets and things confuse you it's just water with a bunch of red proteins in it um and fat doesn't mix with water cholesterol is a fat it's a lipid and it doesn't dissolve in water so we can't just move cholesterol around in the blood the way we move glucose or the way that we move sodium or potassium those things are dissolving in water they're called hydrophilic and they move around freely cholesterol is not it's hydrophobic it repels water so that's why we have lipoproteins we have to have these lipoproteins to move the cholesterol in and out of the body and that gets to the point of there are basically these different types of lipoproteins some of them are very high density they have lots of protein and a little bit of fat in them some of them are low density lots of fat less protein and some are very low density virtually no protein and lots of fat or cholesterol and they have different properties and it turns out that the low density and the very low density ones are the ones that are atherogenic meaning they're the ones that promote the destruction of your arteries okay so something is starting to slowly come into Focus for me so fat in the blood is bad cholesterol or fat which one do you mean I mean fat so when we talk about if if I'm understanding what you're saying correctly there are two times now that fat getting loose is sounded like a problem ah well let's not so so fat is rarely floating around the bloodstream for the same reason but if A lipoprotein if the very low density is indicated because it has very little protein and a lot of fat well just when I use fat there what I'm really referring to is triglyceride and cholesterol but they're inside the lipoprotein they realize it matter that the ratio of protein to Fat starts getting low it only matters in that that's how I'm describing why their difference in density got it yeah so it isn't that it is fat that makes them problematic so what do they do what's problematic is that the low density lipoprotein and the very low density labor protein are the only ones that seem to make their way into coronary artery walls or artery walls in general and they have the potential to get stuck in there so the high density thing no we don't really have a great sense of it it's something about APO B so HDL high density lipoprotein doesn't have apob on its surface it has something called APO a on its surface and when a high density lipoprotein goes into the artery wall it comes back out when AN apob particle goes into the artery wall sometimes it comes out but sometimes it stays in there and when it stays in there or gets retained bad things begin to happen the first of those things is it undergoes a chemical reaction called oxidation that chemical reaction called oxidation creates an inflammatory signal and that tells inflammatory cells called macrophages or monocytes to come they become macrophages and they eat that oxidized LDL molecule that's what kicks off a devastating Cascade in which the body ironically and paradoxically in trying to fix the problem creates a catastrophic problem that ultimately leads to the creation of a plaque that if it ruptures will block the blood supply of the artery and cause a heart attack you've got the two types that end up basically they have the apob on them APO B can get stuck in my arteries once it's stuck in my arteries my body sends it a immune response effectively that then ends up creating a problem uh is that calcification calcification is the final stage of the body trying to repair the problem okay so think of it as the concrete that gets poured on a melting down nuclear reactor so when you get a CT scan that's like what's called a coronary CT scan to look for calcification the presence of that calcification while by itself not problematic is predictive of something bad that's happened I describe I think in the book calcification is like going through a neighborhood and seeing bars on the windows the bars on the windows are actually a good thing they're going to prevent somebody from breaking in right but it tells you what kind of neighborhood you're in yeah okay now that makes a lot of sense going on with my diet one thing that I'm very curious about and there's a raging debate online a capri is just a calorie um where where do you come down on that in terms of the quality of the calorie does it matter if I'm eating Terror like if you agree that the quality of the calorie matters but I'm still under eating do I have a problem so the the calorie is a calorie discussion always needs some clarification are we talking about with respect to energy balance are we talking about with respect to nutrition and health are we talking about with respect to satiety and and so we have to clarify which of those we're talking about all I'm talking about ever is longevity so so then a calorie is not a calorie for sure right so in other words if you took a bunch of people and put you know one group of them on 2500 calories a day of Twix bars and another group on 2500 calories of you know one food only lettuce you know or whatever it wouldn't be 2500 calories but you know 2500 calories of venison sticks venison sticks and another group on 2500 calories of some well-rounded diet that's you know they might all end up with the same weight they might have a different Health Quality and they would I would expect it I clearly don't expect the guy on 2500 calories of Twix bars to live as long as the person on 2500 calories of good food nor do I expect them to feel the same so if you're totally and by the way they might end up at slightly different weights because of how they feel and while you may in this experiment control only their intake you might not be able to control their energy expenditure so they might actually expend different amounts of energy because of how they feel so um the the calorie is a calorie debate I think is kind of a silly one because a lot of times people are talking past each other when they're yelling at each other and they don't understand what they're talking about and so you know we just have to understand are we talking about pure controlled you know calorimetry or are we talking about in your case what you're asking about which is I think more important which is health [Music] okay so uh your book goes into something really interesting which is the emotional side of all of this so what role does that play why does it matter yeah just in a book about longevity I was surprised to see that section happy but surprised well I think um it's not a section that would have appeared in the first five years of my writing this book right like you know we talked about this book took six seven years to write and the first and second versions of this book were very different from the third version which is the version sitting on this table and um I think when this book started out it was a book about how to delay death that was really what the book was about like what do you need to know about heart disease and cancer and Alzheimer's disease and exercise and nutrition and sleep and this drug and that drug to delay death as much as possible um and the book really evolved into what do you need to know to live the best life and I don't think I could write about that without talking about a very important albeit difficult to quantify aspect of Health span which is the side of longevity that refers to quality of life um without ignoring you know by ignoring emotional health it's it's what I consider one of the three pillars of Health span so physical health right all the stuff about your body Freedom From Pain strength flexibility movement all those things cognitive Health the ability of your brain to work and to stay sharp and you know have executive function processing speed memory Etc but then there's this piece called emotional health and so the last chapter of the book is really about that and I think that had I not written that the book would be very incomplete so for you is it about identifying why you do what you do is it about the example that you give in the book is you healing your own trauma um what what is the game there well the you know there's 17 chapters in the book and 16 of them are I I think I'm you know coming across in some way as an authority right like that's it's being written as though at least I know what I'm talking about and I hopefully I do um but I'm writing it as the physician and the last chapter is an area where I write it as the patient so I talk about my journey over the last five or six years in kind of getting better in this Dimension this was always an area of my life that I think was lacking enormously and as a result of that um I think I you know the book has lots of patient examples right the book is written in a in a scientific way but of course you know you never tell a story without making a point and you ever make a point without telling a story well the last chapter I just happened to be the patient in it and that's the the way in which I walk through hopefully a conveying of the importance of paying attention to this what I'm trying to figure out though is what what is that a category of so one thing I talk to people a lot about is meaning and purpose talk to people about emotional control um but there's also the angle of there's going to be a cellular result of your thinking and this is where it starts to get cloudy and so I'm there are people I'll let them remain nameless that uh uh I don't interview this type of person because I think they cross the line between thoughts become physical and uh getting into now we're just making [ __ ] up so that you can think something and manifest it or if you have cancer you can think it away and so I want to know where where is that line for you you felt it important enough to bring it up in a book about longevity was it just though a quality hey I've told you how to get quantity now I want to talk quality or well it's there no no I mean I think there's several things right so so start with the the question as posed To Me by Esther perel have you had Esther on your podcast I have yeah so so people listening will be familiar with her so you know Esther pose this question to me many years ago which is effectively why would you want to live longer if you're unhappy and that's such a obvious question and yet I am amazed absolutely amazed at how much I interact with people because remember all I do is interact with people who want to live longer that's my job everybody I'm talking to everybody who wants to talk to me always wants to talk about how to live longer how to live better in some way and yet very rarely are they paying attention to this aspect of their life what is their relationship like with themselves how well as you put it do they understand themselves what are their relationships with other people how well are they able to regulate their emotions how present are they what is their sense of purpose what is driving them all these things and if that house is in disarray I would make the argument that living longer is a curse not a blessing it's a bold statement push back on it I mean what's what's the definition of torture right so let's let's play a thought experiment if I said to you Tom I'm gonna Grant you immortality in perfect health so it's not going to be like tethonius where I let you live forever but you age forever that would be hell no no I'm gonna allow you to stay right like you are now you're not going to get one more wrinkle on your face you're never going to get a disease would you take it yes I'm not going to give it to anybody else in your life oh yeah I would take that I'm always shocked that other people my wife include wouldn't okay all right so so let's go one step further I'm going to give it no I wouldn't that's so interesting do you know how many people you're gonna watch die wait I'm making the Assumption that's what bothers you why wouldn't you take that um well let's come back to me I want to keep going with you for a minute okay okay so now I'm going to make these I'm going to give you a different experiment we're gonna do the same thing but I'm gonna put you on a desert island now yep and I'm gonna provide everything for you so you're not going to have to worry about finding food um in fact forget the desert island I'm going to keep you in this beautiful house yep and I'm going to somehow keep the lights on and I'm going to somehow keep the food coming in but there will be no other human on this planet for you to ever interact with including your wife would you take that can I kill myself no so I have to live forever like that yes that's the first one where just what I know about the human psyche breaking in isolation I I it would be ill-advised though God I would want to if you'd let me kill myself at any point I would take it but if I can't it's too dangerous no of course you wouldn't take it right I mean you have not in the course for me that is not self-evident and if I didn't understand what happens to the human psyche when it's isolated in in my life where I have been isolated for extended periods of time I have experienced no suffering whatsoever I just I don't disagree with that but I think the question is yeah what's the longest period of time you've been isolated yeah exactly and what does isolated truly mean yeah yeah and if I have input like if you let me keep the lights on and I could have entertainment I've thought a lot about this like uh how much would that help but like let's you saw the movie Castaway yeah okay so if I had any glimmer of hope that I could get off that Island I would want to be alive I would want to try and try but that's a totally different story right yeah this is what I'm saying is even the hope that I could one day recount I'm telling you there's no hope so then I would not I'm going to let you live indefinitely in this house all by yourself yep okay so that's just an extreme example of one dimension of emotional health which is connection to others and I'm I'm telling you that given everything to excess oh and by the way I'll even I'll even sweeten the deal Tom I'll give you all the money in the world and you can buy whatever you want well right now by what oh you could buy Yachts art whatever you want we've we're going to have robots that do everything for you that make everything and you can't interact with these robots I was going to say complicated the robots are not enough they're not going to supplant so there's there's everything I could ever want except for you can have all the cars all the Yachts whatever yep you're not gonna do it if you really stop to think about it you're not going to do it because with no connection to another person it's a meaningless life yep so we could do the same sort of exercise going through all of these different elements of emotional health and I think if people are really being brutally honest with themselves they'll realize that if you you know if your wife hates you if your kids hate you if you're you know you're people around you don't feel good about you and you don't feel good about yourself and you're not you know you don't have a sense of why you're doing what you're doing I think I think it's a I think it's a tough I think it's a tough way to live so it do you think that people asking that question of how to live longer is in some ways not the wrong question but it's just so incomplete that you need to address the emotional side I think it's a very understandable question um I can't speak to others but I certainly through my own experience can understand why one would ask that question and why it's something you would want to grasp on to I mean I think that for most of us the thought of not existing is a little um if not frightening certainly very uncomfortable non-existence is very difficult only on the back side so we all know what non-existence is like try to imagine what you were like before you were born so I don't I it's possible I'm deluding myself it's also possible that I really just see this slightly differently so I have absolutely no fear of not existing if yeah the thought of just not waking up tomorrow only gives me anxiety around ooh did I make sure that I sorted things out for my wife like is she gonna be okay like the thought of something bad happening to her I don't like that um knowing that I'm about to die would change my frame of reference so radically that it would make me immediately behave differently so definitely a huge part of the way that I behave is predicated on that I have more time I try to operate knowing that it's certainly not guaranteed I could have an aneurysm and Keel over and die before the end of this podcast I'm very aware of that um the reason that this feels so important to me and the reason that I was so glad you included it in the book is that I think the only thing ultimately that matters is how you feel about yourself when you're by yourself and if you have earned your own respect I think that's hugely important I just found it very intriguing that not a lot of people are going to cover that topic in your book and I was wondering if there is if it's just that like hey make sure that that it's worth fighting this hard to stay alive and make sure that you're not just driven by the animal instinct to fight or flight and basically you have a vision of your mortality that you're running away from but you're never like figuring out why you live or is there also a sense of if you're in that state where you're very stressed out you're prone to anger or whatever the case may be you're also shortening your life yeah I think it's both Tom and I think that a lot of people are self-sabotaging without understanding why so we have a lot of agency over living longer I mean if there's one thing I hope someone takes away from this book it's how malleable their lifespan is and how malleable their health span is but you have to do things to get that as you pointed out at the beginning of the discussion there is no easy way to do this um there's not a pill or a specific workout or a superfood or a supplement or whatever that's gonna make all of this easy it's a lot of stuff that has to be done over a relatively long period of time and your ability to do that is highly predicated on your relationship with yourself and so you know having sort of poor sleep habits poor nutrition habits poor exercise habits on some level has a component or a root in your emotional health and that's not true for everybody but it is true for a lot of people and I see this constantly in my patients right I see patients whose Own Story whose own narrative is partly an impediment to their actions and so they're suffering twice they're suffering in that they're failure to take actions or their actions that they're taking for example drinking too much are going to actually shorten their life but they're also going to decrease the joy of their life and the harmony of their life for whatever period they have [Music] so let's say that we do everything right let's say we've got meaning and purpose We have dealt with our emotional difficulties we have identified and this is actually something that's really important that I took away from the book you really have to figure out what of the horsemen is coming for you what agent of death from a family history genetic makeup lifestyle all of that which one is most likely to come and get you I think that's very important it might be worth actually recapping who the horsemen are we've touched on them I think all of them but we didn't name them as like these are the horsemen might be worth doing that um but so you've you're doing all this how long can we live like is it really like we're already there it's like 122 and and I hope you get there my friend and follow the book and you'll get to 122. or can we actually push this farther based on what we have today I don't see us exceeding the human record for longevity I think to go beyond that would require a technological breakthrough so I would never represent that you know doing everything to the max with respect to perfect nutrition perfect exercise perfect management of the horsemen through all means necessary that that's going to get someone to exceed that level um you know my thinking of this is that you know we might have 10 years of stretch which is a huge amount if you really stop to think about it right if you're you know life expectancy is 82 and you make it to 92 instead in their quality exactly and that's the point right where I'm really confident we have the capacity to change it is on quality and I you know I said to you everybody comes to me on some level and they want to talk about longevity but when I really probe them what they really mean is Health span they don't care as much about how long they live they really care about the quality at the end of their life I care about both to be really honest as do I healthspan would be if I don't have that it's all meaningless I totally agree with you um I would pay almost any price to live longer and so the for instance um the question that that you asked like I would even if there was an apocalypse as long as there were some other people even if it killed everyone I knew and loved which would be brutal man like I'm I am into my wife in a way most people just are not into their significant other I can tell by talking to them and even that I would if a meteorite hit and it was like your wife is going to die but you can live I'd be like yeah I want to live so my wife wouldn't though she's like if you die I'm going that's so interesting I can't wrap my I mean it depends on my kids but but yes if my wife and kids were not on this Earth I wouldn't want to be on this what would happen if God forbid Peter God forbid I don't have kids because partly because I am so afraid of how devastating it would be if they died but if they died would you want to die um I mean again I I hope I never have to contemplate that but if I lost all of my kids yeah I'd I'd have a hard time probably wanting to go on Wow Wow I get it man look it's it is I I have seen people go through it it is an unbearable thing that I can't believe life asks of anybody but despite knowing how bad that hurts and I would not want to go through it I don't know man and and look of course I might get so rocked I'm just saying hear from an emotional sobriety standpoint where it is just the thought exercise um I don't understand people's response to be like yeah just take me out but let's go back to I think what's the more germane point which is um you want quality of life and length of life I hope what comes across really clearly in the book is those are not mutually exclusive and what I really would like people to understand is if you pursue them both you get them both in fact if you just focus on health span if you just focus on preserving cognition having the most physically robust body possible as you age and pursuing emotional health you are guaranteed to get lifespan benefits as well okay so talk to me about the horsemen let's name them so there's four three of them basically account for the majority of death in the first world one of them directly doesn't account for that much of the death but indirectly probably accounts for the most of it in other words it's the amplifier of the other three so the big three are the diseases of atherosclerosis so heart disease and stroke second one is cancer third one is neurodegenerative diseases inclusive of all dementias so that includes Alzheimer's disease uh Parkinson's disease Lewy Body dementia vascular dementia Etc so those those three really they they show up a lot on death certificates they kill a lot of people the fourth one is more of a spectrum it's not a single disease but it's the spectrum that goes from hyperinsulinemia to insulin resistance fatty liver disease all that metabolic stuff we talked about all the way out to type 2 diabetes and again not a huge number of people's death certificate says nafldi type 2 diabetes a little bit but not not staggering but when you're on that Spectrum the further you get towards the type 2 diabetes side of that Spectrum you're just doubling your risk essentially of all the other three Horsemen do you think that metabolic disease is causative like is basically every non um traumatic death is it Downstream no it's it's it's uh it's neither necessary nor sufficient but it is causative so so you can have causality without necessity and sufficiency so let's take an obvious example smoking is smoking causatively related to lung cancer 100 like meaning there is a causal relationship between smoking and lung cancer but 15 of people who get lung cancer never smoked I don't know the number but many people who smoke don't get lung cancer so similarly metabolic disease is a hundred percent causally related to the other diseases but not everybody who gets met up not everybody who's metabolically ill is going to necessarily succumb to those diseases you could die of something else um and not everybody who succumbs to those diseases had metabolic disease okay that's really interesting there's at least one example you give in the book I'm not sure where you put your own story but you scored a six on the calcification uh scale very young 30 35 and then anahat O'Connor who we bizarrely both know you know them way way way way better than I do but I had the Good Fortune of meeting him um he scored like 126 or some ridiculous thing so is that the kind of example where you guys were both relatively healthy but have this what genetic predisposition well totally different issues I mean anahad as I write about in the book had unbeknownst to him a very elevated LP little a um which is genetic and he was otherwise exceptionally healthy um and is to this day exceptionally healthy but had this genetic issue that was driving you know rapidly advancing heart disease and luckily um you know was caught really early I mean 125 or whatever his calcium score was pretty darn Advanced but to be able to catch that at such a young age uh is is going to make an enormous difference in course correction so had he not had that calcium scan done and acted on it uh there's virtually no question in my mind he would have died prematurely yeah so I was going to ask so if that isn't a driver or isn't being driven by his diet is it purely just genetic luck of the draw yes okay so in the book you tell a story of somebody that came to you they had just the worst deck of cards or hand of cards that you could be dealt around cognitive decline well as in the they had the worst I mean they didn't have the worst fortunately they had you know a very bad hand dealt to them vis-a-vis the risk of Alzheimer's disease so how do you if you get a rough deck hand oh I keep calling deck you get a rough hand like that uh what do you do um you start acting as early as possible to mitigate the risks so we know what one we we have a really good sense of things that people can do to reduce the risk of Alzheimer's disease and in this particular woman's case I call her Stephanie that's not her real name um we we undertake a number of things uh with respect to sleep stress uh nutrition exercise supplements that we know are correcting certain deficiencies such as elevated homocysteine levels um and unfortunately in her case fortunately because she's so young but unfortunately for many people we don't have pharmacologic strategies yet so we're just I think on the precipice of sort of some Precision medicine ideas so for example in our high risk patients who have this Gene the apoe4 gene we are using a new test called the c2n test that measures plasma amyloid and we're using plasma amyloid as a biomarker for the first time now to track interventions so in other words we're using drugs exercise nutrition Etc to try to lower plasma amyloid and high-risk people talk to me about drugs like this is one thing statins comes up a couple times in the book I I the only drug I take is an antihistamine and I would stop doing that if I could figure out what it is either in my diet or my environment that's giving me the allergies but I've had it across like seven different places that I've lived different states I mean just doesn't seem to matter I've had wildly varying diets doesn't seem to impact it anyway so I take an allergy medication um and then I'll sometimes supplement vitamin D but other than that I I just have a real hesitation to take any supplementation whatsoever but you don't seem to have the same fear I have of an isolated compound so you get people on statins if they have early signs of heart disease not necessarily I mean when it comes to managing APO B which is the thing we're trying to manage on the lipid side um we have a lot of classes of drugs statins are one class of drug that's one way to lower APO B is to use a Statin statins also happen to have the most side effects of any class of drug that lower lipids in fact all the other classes of drugs that lower lipids have no side effects statins really have the worst side effects by far so you might say well why do we even tolerate statins like why would we even use them we use them because we have the most data for them they are very efficacious though not the most efficacious and they may have some other benefits that go beyond their APO B lowering benefits so all that has to kind of be weighed and you have to weigh that against the downside of statins which are that a non-trivial subset of people have at least one of two problems in the presence of a Statin one they get muscle soreness the other problem is paradoxically their glucose metabolism Goes to Hell not entirely clear Why by the way but we see dysregulated glucose metabolism in a small subset of patients on statins and again we see in a small subset of those patients about five percent muscle soreness so if we have those symptoms or signs in a person on a Statin and we've chosen a Statin as part of the solution in this lipid lowering campaign we just discontinue it and can it reverses like that but when you prescribe somebody a drug do you do that only when it's like they cannot uh address this via diet and exercise yeah it depends so um it depends on several things so certain so exercise has very little bearing on lipids it has no clinically meaningful benefit on lipids has a much better clinical benefit on metabolic health and blood pressure which are also very important in controlling heart disease so we care a lot about exercise because we want to control those other things that drive heart disease the big three by the way are smoking high blood pressure and high APO B so um again we're trying to do all of this in concurrent fashion as opposed to just you know playing whack-a-mole on one thing um but nutrition has a relatively um minor role outside of extremes at controlling APO B um once a person once you get a person sort of insulin sensitive and once you've normalized their triglycerides unless you're willing to go on profound fat restriction it's very difficult to get apob in the levels that we deem appropriate for um true prevention would you rather put them on profound fat reduction or generally not because it usually comes at such a high cost what's that cost uh usually they end up getting insulin resistant because you're now putting them on a very high carbohydrate diet and they're usually protein malnourished why would that be true so it just is a function of what they're eating so for two years so I used to be 60 pounds heavier to lose the 60 pounds I basically just ate chicken breast and broccoli and while not fun because I was also calorically calor calorically restricting so hard uh uh it was fine yeah and if that works preference though over a drug here's what I say no the answer is no what I say is diet is a way harder problem to get right than drug so let's get the diet right first let's come up with the diet that works best for your metabolic Health your muscle mass your um your sort of fat distribution and your sanity diet is really hard to get right um maybe not for you you're kind of a you know a highly disciplined person but for most of us we want to make sure that we can put you on a diet that you're you're able to stay with for the Long Haul we're not compromising muscle mass we're not compromising metabolic health so if that Diet also happens to produce very low APO B because it's highly restrictive in fat fantastic stay the course in my clinical experience taking care of lots of patients that's not the case for most people for most people the diet that produces optimal muscle mass really good metabolic health and is something that they can tolerate for a long period of time it's not sufficiently reduced in fat enough to have a meaningful impact on their lipids and therefore if we want to get apob low enough to really get into major prevention territory we're going to need a drug okay uh I'm not sure if it's more enlightening to find out what stack of drugs supplements you take or if based on Horsemen that is likely to kill you I have people on these but I am curious what what do you take are you on rapamycin Metformin anything like that um I do take rapamycin I do not take Metformin um I do take uh a lipid lowering drug I take two lipid lowering drugs so one of them is called rapatha it's a pcsk9 inhibitor so it's an injectable drug that prevents the degradation of LDL receptors on the liver so that's specific very specific so it's a very clean drug has no side effects Works incredibly well it's the most potent lipid lowering drug we have did you have a genetic predilection to something that made this necessary I mean I I just only that I have a genetic prediction predilection to heart disease my family history is abysmal for heart disease so um you know once that came into Focus for me I was very clear that I was going to do anything and everything to at least take that off the table right um and that basically means not smoking not an issue having low to normal blood pressure fortunately not an issue and having physiologic concentrations of apob meaning lowering my apob to the level of a child okay and you are you able to get to that or is that what this injectables for I use these drugs to do that got it does rapamycin help with that no so what's rapamycin about explain what it does to people um well I I think that's that's a bit of a TBD right now I mean we we know what it does in the on label use so on label use of rapamycin which is you know taking kind of a medium dose every single day is an immuno is an immunosuppressive dose and that's how rapamycin was approved in 1999 by the FDA for use in patients with solid organ transplants so when you have an organ of somebody else put into you your immune system naturally wants to destroy that organ so patients who get organ transplants kidneys or livers or hearts or things like that they have to be on a cocktail of drugs to suppress their immune system specifically their T cells which are the cells that would normally be going after viruses but now they're going after the organ so um that's nothing to really do with how we're thinking about rapamycin as we're thinking about rapamycin through the lens of what's called Giro protection which means you don't really have a very specific disease you're treating you're more broadly targeting the process of Aging at the cellular level and there um based on a lot of animal data that's very compelling it appears that rapamycin does indeed provide Giro protection um but it's very unclear as to how to dose it to get that and how you dose it in a mouse probably isn't how you should dose it in a human but we don't really know um so if we don't know why am I doing it yes I guess I I'm I'm steeped reasonably well in the literature and I have a strong enough conviction that the way we're dosing it for this purpose has a much higher probability of being valuable than not but I'm gonna be very quick to abort in the presence of new information just as the information that you see in the literature in your blood both all of the above new studies coming out you know there's a very important study coming out in three years um called the Aging uh the dog aging project I believe it's called yeah yeah I had him on the show yeah so so very interesting so if I remember right from uh talking to him basically we're trying to get out of mtor more or less which is my big fear with my diet because I'm I eat so much I mean so much has changed my mind since reading your book but I eat so much protein animal protein specifically I imagine I'm in mtor all the time and so it was is tempting to try rapamycin but is that what's really going on uh not really I mean well yes rapamycin is is an inhibitor of mtor that's that's how the drug Works um but it's not when you eat protein the activation of mtor is relatively short so but if you're eating it all the time wouldn't you then presumably just constantly be soaking that fire not necessarily I mean even if you eat like I do which is no intermittent fasting there's still 14 hours a day I'm eating nothing right so um and again amino acids do not stick around very long in circulation so you know you're they're coming on they're stimulating mtor and then they're gone um if if if um rapamycin's benefit is through mtor inhibition specifically um it's probably more through the inhibition of chronic elevation okay and who knows there may be tissue specificity it may be more about what it's doing in one part of you know in one tissue versus another might not be in the muscle it might be in the liver um there are a lot of unanswered questions here which is why I think the work Matt is doing is really important if you I'm guessing you have a a hypothesis at a minimum of what the mechanism of action is there that is prolonging life like if we think about your whole hypothesis on a sense engineering is that the four horsemen they're just delaying longer than anybody else so what is do you guess rapamycin is doing that causes the delay of one or all of those probably some enhancement of autophagy probably some inhibition of senescent cells possibly some reduction of inflammation is it reducing the creation of senescent cells or just the ramidity with which they're cleaned no it might be inhibiting these secretory factors that they secrete so senescent cells release these factors that effectively are their agents that poison other cells and it might be the case that rapamycin is impairing that process very interesting so that makes me think about cancer so we talked a little bit about that before we didn't go into a lot of detail so cancer I don't know if people are more afraid of Dementia or cancer but both of those are pretty terrifying from in terms of ways to go out with cancer we've I forget how long we've been the war on cancer we've made precious little progress are we barking up the wrong tree like what what is it that either makes that so hard like if we know what it is why is it so hard to deal with and if we don't know what it is why do you think that's evaded our eye for so long well it's a really good question um you're right that we have made scant process in the most important metric of cancer which is overall survival so think about it for everybody who gets cancer we should be asking the question How likely is it that they will not die of the cancer that they just got um um another way to think about that is How likely are they to be alive in 10 years if you're alive in 10 years after getting cancer that cancer is unlikely to be the thing that kills you um and by that metric we've only made about a five to eight percent Improvement in 50 plus years whoa and that Improvement has been largely in some very specific cancers so that's not like across the board we've gotten a bit better it's like no we got a lot better in a couple of cancers namely leukemias and certain lymphomas a couple of other esoteric cancers like testicular cancer and aside from that we haven't really gotten better now very recently there's some exciting news that does seem more applicable to a slightly broader array of cancers which is the form of therapy called immunotherapy so unleashing the immune system to fight Some solid organ tumors has also proved to be and some leukemia's lymphomas has proved to be quite promising but we still haven't figured out a way to unleash that against every Cancer even though in theory it should work right every Cancer should have at least some mutations on it that the immune system could recognize as non-self and we know for certain that 80 percent of them do in fact 80 percent of cancers solid organ cancers so these are the ones that are killing the majority of people right so breast cancer prostate cancer lung cancer colon cancer Etc 80 percent of those cancers have what are called novel neoantigens on them meaning they have antigens on them that are novel to the cancer and recognizable by the host's own immune system the problem is there aren't enough T cells to recognize it to Mount is sufficient immune response so the real challenge of cancer therapy today in my view is going to be enhancing that problem that process rather in other words I think most of the attention on cancer should be on how do we create more reactive antigens in cancer and how do we enhance and extend the longevity of T cells to attract that um so I'm actually surprisingly more optimistic now about this than I was even when I started writing the book because of what I'm seeing with a class of drugs called checkpoint Inhibitors and also for um what I'm seeing with interesting clinical trials where we're seeing the pairing of checkpoint Inhibitors which are immune modulators and conventional chemotherapy drugs which take tumors that are not previously susceptible to this immune modulation but then create mutations that then make them susceptible really clever and cool stuff I I think I write about a couple of examples of that in the cancer chapter so um it's it's easy to be sort of pessimistic about cancer because of how poorly it has gone for the past 50 years but I think the next 10 years look a lot better than the last 50. because of things that are already in motion yeah because of these processes that are in motion so if you got diagnosed with cancer what would be like step number one you what kind of cancer is it is it one that responds to immunotherapy is there like a protocol that you would walk down no it would be entirely dependent on what the cancer was but you know so that gets to kind of step two of my thinking on cancer which is uh is the the unequivocal unambiguous understanding that your odds for treating cancer go down the more cancer cells you have in your body so detecting it sooner in the book you talk about you for your patience you lower the age of colonoscopy do everything much more aggressively so we're you know we're we're doing cult we're doing colonoscopy much earlier much more frequently we're doing how often would you do a colonoscopy oh it depends on the individual I mean in me I do it every three years really yeah and then I do stool-based testing in between what do you check for on the stool you're looking for fecal DNA so you're looking for DNA of the colon cancer yeah interesting it has its own DNA what are we looking for yeah you're looking for the DNA that's shedding from a tumor tumors have DNA other than it's not my own DNA it is your own but it's mutated I mean by definition every I mean cancer is a genetic disease right so cancer by definition has mutations that render it different from the host cell in a way that's predictable uh yeah that's we know what breaks in DNA well we know yeah we know what's we we're sampling what's normal because we see the abundance of that and then we're looking at what's different is there anything abnormal yeah very and that's what electricity how would you do that like the sequencing of that sounds like a nightmare not anymore I mean you can sift through that many samples oh my God Next Generation sequencing can do this stuff like it's it's simple how many sequences would you have to do in a single fecal sample to figure out if there's one like is it a thousand a hundred ten um I think which maybe a better question is what's the Frequency with of abnormal cells that can be detected in the presence of normal and and that's a good question I don't know in fecal uh I don't know in the fecal test I know in the blood test it could be one in a million hmm do you guys speaking of feces uh do you guys look at the microbiome at all no really what don't know what to do with it yet nobody knows what to do with it anybody who says they know what to do with it is probably trying to sell you a supplement that is probably true uh okay so I'm startled meaning look there's no doubt that the microbiome isn't an is an important part of human health like we're not I'm not sitting here denying that or saying the Earth is flat there's no doubt that your diet plays an enormous impact on the microbiome there's no doubt that you know a course of antibiotics will alter like all of these things are true but we're still left with the so what question I've yet to see an example of where someone can show me that I have a person in whom I detect a problem I check their microbiome I make an intervention in response to it that I wouldn't have otherwise made that fixes the problem wow I just don't see those examples okay so man this is very interesting and important to my life so I think we talked about this before my wife seven years ago now I think had a threshold event where she went from having a manageable gut issue to I was legitimately afraid she was gonna die her hair was falling out her nails were breaking she couldn't keep anything down she was in agony at times on the floor couldn't be picked up I was just really really brutal she had to do things like swallow cameras colonoscopy endoscopy like I mean she did [ __ ] everything and this was long enough ago seven years that uh a lot of doctors only sort of knew what a microbiome was like they didn't know anything about it they only sort of knew that it existed and so they couldn't come up with any answers and it was only through finally getting her tested realizing she didn't have enough diversity realizing what we're gonna have to do to start building that diversity back it was a very long journey of figuring out what the things were that she was responding to um dietary enzymes probiotics prebiotics I mean just like this whole arsenal now it may just be oh we didn't actually and and to be honest we don't know which of those things worked and she said many because she takes like 26 supplements a day or something she's like uh I don't know do I still need to take them all she's like I have no idea so she just keeps doing what she's doing and we don't know the counterfactual in these situations and and I guess what I'm what do you mean by that we don't know what would have happened if you did something different yes very true so that this is the problem with this space is we don't have clinical trials upon which to extract knowledgeable or reliable information why I don't know probably because there isn't enough financial incentive for the industries that typically want to do this right like if you're an unregulated industry which is the supplement industry what incentive do you have to do a clinical trial you don't require it to sell your product all you need is marketing so that's why no supplement company is out there trying to run a clinical trial clinical trials are only run by drug companies because they can't sell their product right without a gold standard of a clinical trial so for as much as people want to kind of poo poo drugs and AAA supplements they should really be thinking about this in the other way the burden of proof is much higher on a supplement in the sense that we have no clue if it works let alone if it's not harmful at least the FDA for all of its faults and you won't find many people that are more critical of the FDA than I am I think it's on the verge of being a corrupt organization at least it tries to hold drug companies to some level of efficacy and safety it doesn't always do it but at least it's trying at least they're going through those motions no one's even trying to do that with supplements I mean the supplement industry is such a filthy disgusting industry that even though I take supplements I stress more about sourcing those than I would ever stress about sourcing Pharma hmm okay so in other words you've got to be really careful where you're getting your supplements so if I'm using a probiotic which I do during allergy season hmm interesting a probiotic why you know I I live in a part of the world where there are really wicked allergies and I don't want to get them so I've talked to a few allergists and I've said look what can I do prophylactically during this season in Austin where Cedar fever is out of control and they say well we don't recommend doing immunotherapy until you actually develop the allergy blah blah blah but a couple of them have said look we recommend this probiotic we think it might slightly enhance you know this element of your immune response and I'm kind of like okay I if there's a five percent chance it works and it's not going to hurt me I'll take the chance because the only thing I'm doing is wasting money but like I don't find that to be I mean I do it somewhat reluctantly all right that's so interesting to me that the microbiome would play a role in allergies I mean I get it because so much of the immune system's there but it's just it's such a unexpected twist turn of events for me um even just the discovery that so much my immune system resides in my gut was already startling yeah it's it's it I mean again I think the microbiome is interesting and I really hope we get to the point where we know how to manipulate it um are you do you look at the research on that are you waiting for something more stable oh I intermittently do but but I don't follow that research nearly as closely as what I'm following other things so it's sort of like like every year I'll go back and do a little dive into it with the team and say okay what is there anything we know today and you know year upon year upon year we kind of come back to the same conclusion which is nothing to nothing exciting to report yet I mean there are edge cases right so fecal transplantation obviously very efficacious in some people um do you worry about fmt um I mean there are huge risks associated with it as you know so it's it's it's it's something that should only be done when the risks are justified by the alternative of not doing it yeah we were maybe a month away from me doing fecal microbial transplant with Lisa because I was just like this is scary yeah understandable but for reasons of it just felt like blood transfusions from like the 70s or something where it's like I don't know scanning for the right things very terrifying so what would you have done if I'd come to you with Lisa and said hey uh she's always had gut problems I would have sent you to someone who who does that like again I'm not saying that who though like nobody seems to know like when I say we finally even I couldn't resolve it for her as much as I was learning and meeting with experts like she finally just had to be like when I eat this what do I feel when I eat this what do I feel yeah I mean again this is not my area of expertise so I wouldn't act like it was um you know you'd be like I don't know yeah I'm really happy telling people I don't know there's there's more things I don't know than I do know yeah that is uh that's something that a lot of people struggle with I definitely fall into the other camp where I feel like I know just enough to be like do this come back report so it was really interesting reading your book seeing how much of the things that I felt like uh in fact I'll say this another way I am I'm I'm I have a weird emotional hang up like I really wanna I wanted to say the sentence that I'm gonna stop doing intermittent fasting and and start are doing what you're talking about and I probably should uh do I have orthorexia this is a very interesting question I feel it's so easy for me to maintain my body composition through intermittent fasting it's very easy for me to maintain my uh my satiety through intermittent fasting it's when I click over into ketosis I find that my relationship to hunger is different but you did say that that if I'm doing it for body composition reasons fair enough that's very interesting so one thing that I know I'm just thinking out loud here one thing that I um I do often wonder about with my own physique is protein intake and muscle hardness when you like when I'm being really consistent with working out and I take my carbs up my muscles get really hard will I have a similar effect by and you know why that is right uh the glycogen is being pushed with your muscles it's more water right so more carbs means more glycogen every molecule of glycogen is bringing three molecules of water so you're you're filling up the muscle okay so then is there none of that relevance with proteins I was going to say like it's different right so so protein is contributing to the sarcomere the functional unit of the muscle the the that's that's that's the part that's Contracting right that's the functional piece of the muscle so that's what's increasing the synthesis of the muscle and that obviously contributes to size uh but it contributes just as much to function um but creatine you know will add size to muscle through water retention carbohydrates will add glycogen and water to muscle these things are important for performance also by the way so they're not just an aesthetic thing so carbohydrates uh creatine water protein synthesis all of this matters to muscle if I were eating more protein would you expect my muscles to feel more firm what uh am I going to be able to increase my strength more like it assuming that I hold my workouts the same because I'm trying I'm trying to think through do I change my diet or do I just keep doing what I'm doing now what I'm doing now is easy but I always thought I would say I don't know how you're working out so I don't know right now what you're limited by are you limited by amino acids or are you limited by Progressive overload or are you limited by some other Factor so meaning I'm not overloading the muscle enough yeah are you over are you putting enough stress on the muscle or not uh do you have a high enough testosterone or not do you have enough amino acid or not any of those things can be the bottleneck um and uh you're at the limit of your genes right like all of these things start to matter now my guess is virtually nobody is at the limit of their genes except for bodybuilders so I'm not at the limit of my genes what am I at the limit of right now probably and I'm not at the limit of protein anymore I'm probably at the limit of how hard I'm willing to train how much I'm willing to train and actually I'm probably at The Limited testosterone as well because my T is pretty low so I can't answer the question for you what is more protein going to do because I would need a lot more information to understand like how your training what's your training volume what's your training intensity and you know all those factors okay so one thing while I have you that I I will say is my limitation when I think about what holds my physique back I get injured a lot and I get injured in a very specific repeatable way which I think has to do with stability which you cover in the book so um I have a very weak middle back and I compensate for everything by shrugging my traps so it almost doesn't matter what I'm doing like brushing my teeth I will suddenly realize Jesus and I have to like remind myself to I think it's uh retract my scapular like I'm pulling that sort of mid-back girdle down in the book you go into how you can rewire the way that your brain has learned to control your musculature what what is that process I have injured my trap you're gonna think I'm exaggerating I've injured my trap 115 times over the 20 years when you say injured your trap so you sent it into spasm so where I can't turn my head or I can't tilt my head uh literally last night in bed I was rolling over so just adjusting my posture and it went and I was like you've got to be [ __ ] kidding and so then I couldn't fall back asleep because I could just feel it tightening and tightening and tightening and tightening that is the thing that has has held me back for forever it's the first injury I ever received the first day in the gym doing an overhead press it went and I thought I was dying at that point I was like what the [ __ ] uh yeah I've injured it probably at least 115 times again it would be impossible for me to kind of give you the diagnostic here but I think I think if you think about the way I kind of go through that stability chapter um it starts with respiration so the first thing we'd have to understand is what's your respiratory strategy um so are you over inflated under inflated chest breathing only abdomen breathing only all of these things um are you chest out are you hunched over like you'd want to go through how do you correct your your respiration strategy um and then you'd want to look at do you have for example segmental control of your spine most people do not I can't imagine yeah so until you have segmental control of the spine you are always going to disproportionately put Force at various hinge points in the spine do you have thoracic mobility of your spine sounds like you don't have thoracic mobility of the spine do you have scap is thoracic Mobility so are you able to rotate through the thoracic spine so you have a cervical spine thoracic spine is the longest segment and then the lumbar spine so most people don't have segmental people that like twist themselves on a chair that kind of thing like how would you do that yeah but if you do twist where are you twisting through where is the torsion what part of the spine for me almost certainly lower back exactly that would be the most common so most people are excessively applying torsion in the lumbar spine and you want to be able to dissipate it through the whole spine also when you talk about the flexion extension of the spine and by the way we made a bunch of videos like because you can't explain all this stuff in words so in the book there's a link to like videos where I go through what these things look like but you know being able to do a segmental cat Cow exercise is a really good way to see if you have segmental control of extension and flexion of the spine from head to tail um so you know then we get into sort of do you have scapular control through the full range of motion through all four phases so protraction retraction elevation depression again very few people can can control their scapula through those things so stability and movement are uh you know intertwined very intimately and if you you know if you're trying to unpack these injuries you generally have to go back to the breath training how to train yourself how to breathe properly training yourself how to move properly and there are two schools of thought that I have relied on very heavily in my journey here and that of my patients and that one is called Dynamic neuromuscular stabilization DNS the other is called postural restoration Institute PRI bringing everything that I've learned from this conversation and the book today tell me if this makes sense so I I would like to add more muscle to my frame do you know how much muscle mass you have right now I don't have you had a dexa scan I haven't man I'm really like I love that stuff but because no one's coming to my house to do it uh I haven't gotten tested be very interesting you can't do it at your house you kind of have to go to the machine I'm willing to do it I would be very keen to figure that out one I want to see if I haven't well you should get a Baseline and you should you know you should figure out like where you are where do you stack up right now in terms of muscle mass if for no other reason then you can evaluate your progress if you let's say you you know you test your almi it's at the 70th percentile that's great but do you want it to be at the 80th percentile well this way you can figure out if the changes you're making are going to move you in the right direction or not all right so making my goal maybe even more broad is something you talk about in the book which is the centenarian decathlon uh so what are the things you want to be able to do when you're older you better be scoring very high on them depending on what part of your age you're in now because it's all going to decline as you get older so here are the things I feel like I should be implementing based on I am 47. okay and so what do you want to be able to do 40 to 50 years from now I want to be able to be very independent from a Mobility perspective so I love the idea of being able to when I'm flying to Mars to be able to hold I guess before we Blast Off be able to put luggage above my head uh uh so yeah I want to be able to travel put things above my head I don't want to lose a lot of my strength I want to make if you want to go to Mars by the way you're going to tolerate pretty high g-forces so think about the next race that's going to be required to do that yes also I would just like to not have constant trap injuries that'd be amazing um I want to be able to play video games okay I don't play video games I do drive a simulator though so that's probably similar uh I would guess not from the perspective of what I struggle with so I had so much wrist inflammation for so long I think a lot about inflammation inflammation keep that down so you thank you by the way you're encouraging me to add fat to my diet allowed me to go from basically never being able to play video games to I can now play as much as I want on Saturday which I mean I I'm sure I could play more than that but that's just from a Time allocation standpoint so uh that's been a huge one so being able to do that sex huge thing in my life so being able to whatever that takes so a certain amount of flexibility I imagine and uh stamina et cetera et cetera [Music] yeah Aesthetics I want to look good I want to be strong look strong um something cognitive like being super sharp that would be really important well I mean if you're playing video games presumably you've got to have pretty decent cognition right you've got to have um certain skills and depending on if you want to be doing this yeah also true I don't need to pick up grandchildren that would be the maybe one deviation from what a lot of people want to be able to do but being able to be physical active I mean take sex is my like I want to be able to do that to the fullest um so given all of those things here's sort of how I see this now breaking out um sleep which we didn't really get into but I obviously I'm gonna need to get sleep that's going to be super important I'm going to need to identify given my family history I think it's either going to be cancer or heart disease neither sort of overwhelmingly prevalent um but those would be the two where grandparents died of that so certainly want to be thoughtful about that so I'd identify those two Horsemen so I'm going to be really thoughtful around my diet making sure that I don't have fat spilling out that I'm really thoughtful about the um that's the one that gets into my cell walls arterial walls yeah and you do need to check your LP little a which is the thing we talked about as well that is genetic and occurs in about eight percent to 12 percent of people okay so uh paying attention to my diet uh the adjustment that I'm thinking about making my diet I'm gonna test not doing intermittent fasting see what that does for my muscle mass um eating more protein I have a feeling I might be lower in protein though I haven't counted up the eggs I eat a lot of eggs um and then I'm really curious to see about cycling rapamycin so what is your cycle on rapamycin um I just dose it once a week just just take one dose once a week yep okay very interesting um trying that what other changes you're gonna have to have a doctor help you with that that's that's not an that's not an over-the-counter yeah yeah yeah for sure for sure I obviously would be doing this on the back of a lot of blood testing to make sure that I um a that I know what my Baseline is B then I'm actually getting the result that I want to see um so yeah looking at the number on the um the cholesterol that we were talking about earlier grip strength is going to be one again not you know not sitting around with a little one of those like little grip squeezers because that's not really what it's about it's how do you develop grip strength you develop it by carrying heavy things right so you know this morning I was dead lifting and because I was doing it in the hotel and I didn't have chalk I was failing in grip today like it's actually funny my hands and my forearms are still sore five hours later because I was really at the limits of what I could do without chalk and you know I didn't have anything else so so but so yeah I was dead lifting but think about how much I was doing for my upper body even though that's a lower body activity um you know doing farmer carries something I love doing I mean I'm always trying to figure out a way to use my upper body to maximize the relationship between grip and shoulder so think of it less as like very specific tests that you do and think of it more as the the broader activity you need to do to produce that so grip strength is just an integral of upper body strength all right so if if that is my sort of fumbly way through the things the changes that I'm gonna make um if somebody wants to outlive and they come to you that cocktail party and you just cannot get away from them and you have to answer the question in a succinct way um what do people need to do to maximize the human life expectancy there is no sentence I can give any person to tell them what the prescription is right I mean if I could I wouldn't have written a 500 page book there's no chance believe me I didn't want to write a I wasn't look I wasn't looking for things to do right the reason this is complicated is that it's complicated and two people can have two very different prescriptions you know if I'm at that cocktail party and the person I'm talking to after a few minutes I figure out that their biggest issue is that they're not sleeping you know or that you know they're sleeping four hours a night nothing else I'm not gonna really waste time talking about protein with them we've got to figure out why they're not sleeping seven to nine hours a night and how much of that is sleep hygiene how much of that is underlying pathology like sleep apnea or restless leg syndrome how much of that is alcohol how much you have to get to the root of that problem but if you're sleeping four hours a night that's the elephant in the room if you're not exercising at all and you're sleeping well and you're sort of eating okay like none of that other stuff matters you need to get exercising if you have type 2 diabetes and metabolic syndrome you know I we have to get you exercising and changing your diet and all those other things so so again it I'm not being difficult because I don't want to give glib answers I I'm not giving a globe answer because there isn't one very fair all right where can people engage with you to get the non-glib details on all of this uh I think if you go to our website Peter attiamd.com and sign up for our free newsletter you'll very quickly get brought into our world where every Sunday we're gonna spit out something that me and my research team have written on all these topics I love it all right guys if you haven't already be sure to subscribe and until next time my friends be legendary take care peace click here to learn now the top five foods you should never eat I have done the vegan thing I have tried the low protein thing it will provably make you feel like crap which will make you wish you didn't live longer

Channel: Tom Bilyeu

Views: 1,122,330

Keywords: Tom Bilyeu, Impact Theory, ImpactTheory, TomBilyeu, Inside Quest, InsideQuest, Tom Bilyou, Theory Impact, motivation, inspiration, talk show, interview, motivational speech

Id: orJa62raA4w

Length: 155min 21sec (9321 seconds)

Published: Thu May 25 2023